Sleep apnea: creating a society of the walking dead

[Guest guest]

Sleep ... wake ... sleep ... wake

Sleep apnea is gradually creating a society of 'the walking dead'

Zdeb, The Edmonton Journal Monday, April 21, 2008

This the first of a two-part series on sleep apnea. Next week, sleep

apnea and children.

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EDMONTON -- Many of us are functioning on too little sleep, but how

about having to put your car in park at every red light because you're

afraid you'll doze off and drift into the intersection or the car

ahead of you before the light changes?

That nightmare was Larry 's reality for several years until he

was diagnosed with sleep apnea, a sleeping disorder where a person who

is asleep may stop breathing multiple times for more than 10 seconds,

resulting in a poor night's sleep and daytime drowsiness.

At least four per cent of men and two per cent of women are believed

to have significant sleep apnea and, anecdotally, the number seems to

be growing, partly because the population is getting heavier.

Obesity-hypoventilation syndrome is an extreme form of sleep apnea.

Basically, people can't get rid of their carbon dioxide as they sleep,

so it builds up, resulting in heart failure, explains Dr. Irvin

Mayers, a respirologist and director of pulmonary medicine at the

University of Alberta Hospital.

" In the past, obesity-hypoventilation was pretty unusual. Now, in our

in-patient hospital service, we usually have at least one or two out

of 20 people admitted for that, " he says.

Obstructive sleep apnea is the most common form of this sleep disorder.

It's the result of muscles in the upper airway, around the base of the

tongue becoming so lax, they collapse and close off all airflow.

But when started waking up sleepy every morning, after what

seemed to be a solid seven hours of sleep, he at first chalked it up

to being a retired phys-ed teacher who wasn't as active as he used to be.

" My energy level had dropped off, my vitality had dropped off and I

was thinking it was because I wasn't staying in shape, wasn't eating

properly, " he says.

It wasn't until a relative at a family gathering started telling

about how well he was sleeping and how good he felt since being

diagnosed with sleep apnea and doing something about it, that

started thinking maybe he had the same problem.

His wife , a sound sleeper, had never complained about 's

sleep until he went to bed before her one night and she heard him

snoring and noticed there were times when he would also stop breathing.

saw his family physician, who referred to a sleep

doctor, who gave him a mask-like device to wear at home one night.

The mask analyzed his sleep and was shocked to find he snored

over five hundred times an hour and stopped breathing about 14

different times.

It's normal for all muscles, including those at the back of the

throat, to lose tone during sleep especially during REM (rapid eye

movement) or dream sleep, Mayers says. But in some people the muscles

are so flabby they close off the airway.

When that happens, there is an automatic reflex that wakes them up

enough for the muscles to regain tone and restart breathing, until the

airway closes off again.

" If you wake up very, very briefly, your brain won't remember that at

all. As far as it's concerned, you were sound asleep all night, but

the reality is you woke up 30, 40, 50 times an hour, " Mayers says.

The worst case he's seen is 110 obstructions an hour. " That's really,

really severe; you'd be barely breathing the whole night, " he says.

The sleep quality of someone with sleep apnea is so poor the brain

doesn't get the deep, restorative sleep it needs to function properly

the next day, so they're always falling asleep, including at

inappropriate times such as while at work, or while driving, Mayers says.

" If you hear of a single-vehicle crash and alcohol wasn't involved,

it's usually a case of sleep apnea, " he says.

People with sleep apnea are three times more likely to be involved in

a motor vehicle accident than the average person, which puts the

general public at risk.

" It's also becoming clear that sleep apnea is a health hazard,

increasing a person's risk for high blood pressure, heart attack and

stroke, " he adds. " It increases their risk of depression. "

Sleep apnea is a scary and tiring experience for light-sleeping bed

partners who spend nights elbowing the person awake whenever the gap

in their breathing seems to go on too long, and it can go on for as

long as a minute.

Because we live in a sleep-deprived society, Mayers thinks sleep apnea

isn't treated seriously enough.

This isn't just one bad, sleepless night that most people experience

occasionally; this is waking up feeling terrible every day for 10,

sometimes 20 years, he says.

There are two well-tested approaches to treating sleep apnea.

One is a custom-fitted dental appliance that pulls the lower jaw

forward, widening the airway, but it usually only works for mild sleep

apnea -- fewer than 20 sleep disruptions per hour, Mayers says.

The other treatment is a CPAP (continuous positive airway pressure)

mask/machine which splints the airway open.

" People with sleep apnea have a diminished quality of life and when

they get treatment with the CPAP, their quality of life comes back to

that of the average person. So, even ignoring the other health

benefits, it makes a huge improvement in how they feel, " Mayers says.

Larry , who sleeps with a CPAP mask, noticed within a couple of

days that he was no longer waking up with what he calls " a brain fog. "

" My quality of life has really improved, " he says.

Anyone waking up chronically sleepy, even though they think they slept

through the night, and think they're getting enough sleep, should

raise the issue with their family doctor.

They might just have a sleep disorder that's treatable, Mayers says.

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APNEA SIGNS

Symptoms of sleep apnea may include:

- waking often during the night

- not feeling refreshed after sleeping

- daytime sleepiness and fatigue

- impaired daytime performance

- trouble with memory and concentration

- snoring

- struggling or gasping for breath while asleep

- pauses in breathing (longer than 10 seconds) during sleep

- irritability or short temper

- mood or personality changes

- depression

Sleep apnea can be made worse by: alcohol, sedatives, sleeping pills,

narcotics, anesthetics, weight gain, sleeping on your back, nasal

congestion, smoking, not getting enough sleep, aging, heart or lung

disease.

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