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September 5, 2004
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Tom and Bea Thompson
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Until last year Bea Thompson had never even heard of sleep apnea. But while her husband Tom was in the hospital for a short stay, his doctor scheduled a visit for him at a sleep clinic after noticing Tom’s awkward sleeping pattern.

Needless to say, when Tom, 59, died in his sleep two days before the appointment, Bea Thompson was shocked.

What is Sleep Apnea?

Sleep apnea is a breathing disorder that’s caused by the relaxation of the throat muscles during sleep. The muscles relax so much that the upper airway becomes blocked. As the airway collapses, a person will start snoring loudly, but then as the muscles continue to collapse there’s silence because airflow is totally blocked. This causes the person to snort or gasp for air, partially waking himself in the process.

Blockage from sleep apnea can last anywhere from 10 to 50 seconds, according to Dr. Neil Kavey, director of the Sleep Disorders Center at New York Presbyterian Medical Center in Manhattan. It’s not so much the interruptions in breathing that are dangerous, says Kavey, but the consequences of repeating the process.

Chris Larobina, a 26-year-old administrative assistant from Norwalk, CT, was diagnosed with sleep apnea two months ago. He was told by doctors at a sleep clinic that during a six and a half hour period of nighttime "sleep," he was actually only getting 16 minutes of deep sleep. "Because people with apnea are repeatedly awakening over the course of the night to open up their airway, they experience daytime tiredness and sleepiness," says Kavey. "They often wake up in the morning and don’t feel very refreshed, they’re sleepy during the day and fall asleep at inopportune times." Falling asleep behind the wheel of a car is probably the most dangerous consequence of such sleep deprivation.

Sleep apnea also causes oxygen levels in the body to drop due to the blocked airway. According to Kavey, this can lead to cardiovascular problems like changes in heart function, enlargement of the heart, congestive heart failure, cardiac rhythm irregularities, and increased risk of heart attacks and strokes.

What Are the Risk Factors?

Sleep apnea risk factor animation

These are the most common, but women do indeed get apnea, and people with particularly small jaws and who are always sleepy (despite getting seemingly adequate sleep) are also considered at risk. Snoring in itself does not necessarily indicate sleep apnea (up to 50 percent of middle-aged men snore), but the disorder is much more widespread than many suspect: About 30 million Americans suffer from sleep apnea, according to a 1993 landmark study published in the New England Journal of Medicine.

"We’re not talking about a rare disorder, we’re talking about something that’s very common," says Kavey. So common, in fact, that in 1993 the National Institute of Health established the National Center on Sleep Disorders Research, following a report to Congress that identified sleep problems—apnea among them—as a public health crisis.

It’s a silent crisis, though, because many people don’t take sleep disorders like apnea seriously. "Death and even very serious health problems from apnea can be prevented, and it’s very important that people be aware that these loud snoring sounds and these pauses and these gasps aren’t laughable matters," says Kavey. Bea Thompson agrees. "[Tom] snored and it was a comforting sound. . . so I just listened for it and I would fall asleep," she says, adding, "I wished I knew more about it."

So What Can Be Done About It?

Luckily, sleep apnea is easy to diagnose and treat. All it usually takes is one overnight visit to a sleep clinic to determine if someone has sleep apnea. Using a test called a polysomnography, doctors monitor brain waves, muscle tension, eye movement, breathing, and oxygen levels in the blood. They also observe sounds the person makes while sleeping, such as snoring and gasping.

CPAP mask and headset for sleep apnea
image: Airsep Corp

Once the patient is diagnosed, there are a number of treatment options available. The most common is a breathing machine, called a CPAP (continuous positive airway pressure), that blows air through the nose to open the blocked airway. Patients using a CPAP have to sleep with it every night, which takes some getting used to, but the results are often good: Chris Larobina says he feels much less tired since he started using his CPAP machine two months ago. (And besides resolving the apnea problem, CPAP may help in other areas as well. A study released this week at the American College of Chest Physician’s World Congress showed that apnea patients using CPAP reported improved sexual functioning.)

For less severe cases of apnea, there are mouthpieces that adjust the position of the jaw, pulling it forward to open up the airway. These devices also help in treating snoring.

image: Excel Dental Studios

Surgery is another option for apnea sufferers. Using various techniques, surgeons trim away extra folds of tissue in the airway. One, called somnoplasty, uses radio waves to shrink tissue in air passages. It’s done as an outpatient procedure using local anesthesia and causes little pain and swelling. Originally used to treat snoring, somnoplasty was approved last year by the FDA as a treatment for sleep apnea.

But diagnosis is the first step in the process, and Bea Thompson urges people to see their doctor if there’s even the smallest suspicion of apnea. "You don’t have to die from this," she says, noting that she wishes she and her family had known about sleep apnea and how to treat it sooner. "This is a terribly important diagnosis to make," adds Kavey. "It frightens people, but on the other hand we have treatments, and when we treat somebody with sleep apnea their world changes completely."


 
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