Sleep apnea

Originally Published: May 10, 1996 - Last Updated / Reviewed On: October 10, 2008
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Dear Alice,

This isn't much of a question, but I'm definitely in search of an answer. I suffer from sleep apnea. My throat collapses when I go to sleep. I have to strap an air pump (CPAP) to my face at night. I've been wearing this thing for almost two years. Without it I awake an average of 78 times an hour. Although I'm much better with the CPAP, I feel as though this disease is still going to kill me eventually. The CPAP seems so barbaric. Isn't there any new solutions to my problem?

— Very Tired Indeed

Dear Very Tired Indeed,

Your sleep disorder is both common and cruel. An estimated 20 million Americans — mostly overweight men — experience collapsing mouth and throat muscles that block the intake of air during sleep. Despite these numbers, sleep apnea is frequently not treated directly because its symptoms are thought to be those of depression, stress, or plain old loud snoring.

One of the primary tip-offs to sleep apnea's presence is a very pronounced snore — more like a loud and sudden snort. This "gasp for air" is literally a lifesaver when the mouth and throat muscles tense up to allow air back into the body. Most sleepers are unaware of this occurrence, although it often shakes their bed partners, roommates, and even neighbors to the core. When people with sleep apnea fall back asleep, relaxing muscles once again cause airway blockage. As you noted, this vicious cycle is repeated over and over again each night.

This roller coaster sleep pattern leads to a loss of energy, concentration, and productivity, and an inability to stay awake during less active tasks, such as reading, watching television, and driving. In serious cases, the continuous oxygen deprivation caused by sleep apnea can lead to high blood pressure, heart attacks, strokes, and even sudden death. There may be a genetic component to this disorder as it often occurs within families.

What can be done to better manage or cure sleep apnea? In less severe cases, weight loss and a reduction in alcohol and other sedative use before bedtime has been a successful remedy. Sleep experts also recommend that people with sleep apnea should not sleep on their backs; sometimes sewing a tennis ball into the back of a nightshirt can prevent this from occurring. In more serious cases similar to yours, continuous positive airway pressure (CPAP) machines blow air through a mask into the body during sleep. Although this treatment has also helped many people, some cannot tolerate this method, and may benefit from oral devices that change the position of mouth structures during sleep.

Surgery is a further option. Some surgical procedures reconstruct the nasal passages or remove tissue from the back of the throat to create a larger airway. Other procedures move the bones or tissues in the mouth forward, again opening the airway. In most cases, more than one surgical procedure is needed to ensure complete success. People who have sleep apnea may need to try several different strategies and/or possibly surgeries before they find one that solves their problem.

Seeking treatment for sleep apnea usually involves visiting a sleep lab where heart, blood oxygen levels, and other vital signs are monitored by professionals. For more information on sleep apnea and resources for help, you can contact the National Sleep Foundation and the American Sleep Apnea Association.

It is good to hear your acknowledgment of improvement with the aid of CPAP, and your discomfort and fears are certainly understandable. Discussing both new treatment options and perhaps surgery, or even your feelings related to CPAP, are all part of the ongoing relationship with your health care provider.

Alice

October 10, 2008

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To the reader:

Remember that while most people with sleep apnea snore, not all do. My partner was finally diagnosed with sleep apnea at the age of 26 — her current doctors believe she...
To the reader:

Remember that while most people with sleep apnea snore, not all do. My partner was finally diagnosed with sleep apnea at the age of 26 — her current doctors believe she had probably never "slept" in her life, she had only had fits of controlled narcolepsy.

Instead of snoring, my partner had a long list of other health problems and conditions, most of which were treated at some point, but the treatments never worked as well as they ought to have. In retrospect, this seems obvious — the root problem of never sleeping had never been solved.

Memory problems — there's a long list of things she couldn't learn to remember, but the prime example was where she put her keys. What we know now, is that she couldn't form memories of setting something down. Things just kind of fall out of her hands, and unlike most people there's no memory of setting it down.

Lowered immune system — when your body doesn't get sleep, it can't fight off sickness, chronic bronchitis as a child, and we could almost guarantee that a cold most people could kick in a week, she'd still have in a month.

Lifelong insomnia, or delayed sleep disorder — the body can develop a fear of going to sleep. Every time you stop breathing, the body goes into full on emergency response to wake you up and start breathing again. When this is happening at least once a minute, in some cases much more often all night, it's no wonder your body is afraid to let you fall asleep.

Hypoglycemia — the body also has trouble regulating sugar levels when it doesn't get sleep. Nausea and vomiting - standing outside with her while she vomited was a regular occurrence every morning at school -due to sleep deprivation. Unfortunately this was misinterpreted as everything from "stress" to bulimia. And on bad days if a teacher caught her, she'd be sent home for being sick — a school policy that lead to her missing a lot of school.

Obesity — without genetic precedent, or poor eating habits. My partner is a large framed woman, but she's also extremely strong there's a large amount of muscle hidden under the fat. Lack of sleep, meant her body chemicals weren't regulating properly and actually caused her body to put on weight, and keep it on regardless of how little she ate (there were months where she barely kept food down the nausea was so severe), or how many walks she went for.
If this wasn't bad enough, not sleeping is devastating to your ability to cope with stress, which can bring on, or significantly increase the severity of clinical depression. This can be ridiculously difficult to cope with, while also dealing with this many medical problems, doctors appointments, medications which were sometimes worse than the symptoms... and a lack of compassion from a lot of people around her.

Finally, this year, at age 26, one university professor noticed that she seemed to be unable to remember hard facts, which was grossly disproportionate to her knowledge of concepts, reasoning skills, etc. Months after psychological testing concluded that something was indeed "weird," and many doctors appointments later she was diagnosed with sleep apnea. Because it's so severe in her case, and it's gone untreated for so many years recovery is slow. It's explaining many of her medical problems though, and slowly, she's beginning to realize that her weight is not something she could have done anything about.

The years of self hatred are hard to let go of though... that will probably take longer than any of it. If your intuition tells you something is wrong, but your doctors won't listen, keep looking until you found someone who will listen and work with you. The easy diagnosis isn't always the right one. I've slept next to her for 8 years, and she's never snored, but she definitely has sleep apnea.