During his physical, Mr. Simpson mentioned he was often tired. When I quizzed him about his sleep habits, he responded, “I don’t think I have trouble with sleep; I can fall asleep anywhere, anytime. Trouble is, I don’t feel all that rested when I wake up. Now my wife, she don’t sleep so well; she says it’s on account of my snoring, which may be true … though I’ve never heard myself snore.”
Mr. Simpson was substantially overweight, with high blood pressure, and often suffered from morning headaches. In the end, we did a sleep study and found that he had a disorder known as obstructive sleep apnea (OSA).
OSA is a condition where a person, despite adequate respiratory effort, moves air in and out of his or her lungs inadequately while asleep. The person may stop breathing for intervals of 10-30 seconds or more, often resuming with a loud snorting or snoring sound.
OSA turns out to be quite common, and increasingly so as Americans’ average weight steadily climbs, though lean individuals can (less commonly) have sleep apnea as well. Estimates vary, but it is thought that up to 10% of middle-aged women, and probably at least twice that many middle-aged American men have OSA. The majority are undiagnosed. Some children and adolescents also suffer from OSA.
What symptoms or risk factors should make you suspicious that you or someone you love may have sleep apnea?
• A neck circumference equal to or greater than 17 inches in men or 16 inches in women
• Daytime sleepiness
• Feeling unrested
• Morning headache or sore throat
• High blood pressure that is difficult to control
• Loud snoring
• Awakening with gasping or shortness of breath
• Witnessed episodes of stopped breathing while asleep
If you have a few of these symptoms, check in with your doctor. Nowadays many sleep studies are able to be done at home quite easily. The study will reveal whether you stop breathing, how often you do it, how long each episode is, and what your blood oxygen does while this is going on. How many times and how loud you snore is also measured, and the results are often met with a knowing smile and nod from the spouse.
If OSA is confirmed, options such as CPAP, which delivers air with sufficient pressure to greatly reduce apnea or hypopnea (shallow breathing), are discussed. Occasionally oral surgical procedures or appliances may be appropriate.
Mr. Simpson did, in fact, end up doing a home sleep study and was positive for moderately severe OSA. A month after starting treatment with CPAP he said that it had “changed my life” and his energy and alertness had radically improved.
Of course results vary and some have a harder time than others adjusting to wearing a CPAP device at night. But today’s CPAPs are smaller and quieter and auto-adjust the right pressure to a person’s airways.
But, why do we bother to treat OSA? For one thing, as with Mr. Simpson, many sufferers just feel so much better when they treat their OSA. Besides that, OSA is a serious medical condition that is associated with an increased incidence of hypertension, cardiovascular disease, coronary artery disease, insulin-resistance diabetes, depression and sleepiness-related accidents.
So, if you found yourself nodding off while you were reading this, better get it checked out.