Living with Obstructive Sleep Apnea

I first began to suspect I might have sleep apnea about four years ago, when I noticed myself snoring so loudly I could wake myself up. I had wanted to see a doctor then and get check out to find out for certain, but did not, fearing that my insurance would not cover the sleep study. I had always intended to call and find out if I could have coverage for the study, but somehow never got around to it.

Over the next two years, I met and married a wonderful woman. And then once again, suspicions of sleep apnea began to creep into my life. In addition to my snoring, my wife began to notice that I would stop breathing for several seconds, and then my body would begin to shake as I would try to get some air into my lungs. I was also suffering from daytime sleepiness, as I would often fall asleep sitting on the couch at home, at the movie theater, and in church. My wife and I were agreed that once I had the appropriate coverage, or as soon as we could afford it, I would get checked out for sleep apnea and look into treatment options.

Then my problems began to creep into my work. I am a security officer, and I was working midnights in an alarm center at a utility company late last year. Then one day, I was informed I had been observed sleeping at my post, and was being removed from the account. Fortunately, the security company was willing to place me on a different account, working at a different shift. But my wife and I had come to the realization that something needed to be done about my "problem."

According the National Institutes of Health, approximately 18 million Americans suffer from sleep apnea. That's roughly twenty percent of the adult population of the United States. The Journal of the American Medical Association reports that approximately one in five adults has at least mild obstructive sleep apnea, and one in fifteen has OSA of moderate or worse severity. According to the NIH, while nearly four percent of men and two percent of women over the age of thirty-five are diagnosed with sleep apnea, that as many as ninety percent of all cases remain undiagnosed. This is due, largely, to the fact that most sleep apnea sufferers are unaware that their symptoms are a sign of a breathing disorder, or that effective sleep apnea treatment is available.

Obstructive sleep apnea is characterized by repeated episodes in which the upper airway becomes obstructed during sleep. This usually occurs when the soft tissue in the rear of the throat collapses and closes the airway. During these episodes, a person is unable to breathe in and out to exchange oxygen and carbon dioxide. The result is lower levels of oxygen in the blood while carbon dioxide levels increase. The brain is alerted to the decrease in oxygen and the increase in carbon dioxide, causing an arousal. During these arousals, the brain sends a signal to the upper airway muscles to open the airway. The resumption of breathing is often accompanied with a loud snort or gasp. While arousals are necessary to restart breathing, frequent arousals prevent the body from getting restorative, restful sleep.

Symptoms associated with obstructive sleep apnea include loud snoring, periods of not breathing, waking without feeling rested in the morning, abnormal daytime sleepiness (includes falling asleep at inappropriate times), morning headaches, recent weight gain, limited attention, memory loss, poor judgment, personality changes and lethargy. Additional symptoms may include hyperactive behavior (this is especially true with children), high blood pressure, automatic behavior and, in severe cases, leg-swelling.

The consequences of undiagnosed or untreated obstructive sleep apnea range from disruptive (learning and memory difficulties, irritability, depression, daytime fatigue and sexual dysfunction) to life-threatening (stroke, congestive heart failure, irregular heart rhythms and cardiovascular disease). A report in the New England Journal of Medicine estimates that about one third of all patients with heart failure have OSA.

After I lost my post at work, I spoke to my doctor about my symptoms and the suspicions my wife and I had held about the likelihood of my having sleep apnea. The doctor had me report to the sleep lab at St. Anthony's Hospital in Alton, Illinois the following week for a sleep study. While I slept, the technicians monitored the electrical activity of my brain, eye movement, muscle activity, heart rate, respiratory effort and airflow, and my blood oxygen levels.

After nearly three hours, I was awakened and informed that I did, in fact, have severe obstructive sleep apnea. I was fitted with a mask to wear attached to a CPAP (Continuous Positive Airflow Pressure) device. Then I spent the rest of the night sleeping while the technicians tested various air pressure settings to see which one worked best for me (a process called titration). Three weeks later, I returned to my doctor's office, where he gave me a prescription for a CPAP with the recommended pressure setting.

CPAP is the most common form of treatment for OSA. It involves the use of a mask worn over the nose (or over the nose and mouth) while a steady stream of air is supplied during sleep. This steady flow of air keeps the air passage open to prevent the airway from collapsing. Other treatment options include weight loss (In fact, a loss of even ten pounds can reduce apnea significantly), changing sleep habits such as sleeping on one's side rather than on one's back, behavior modifications including avoidance of alcohol and sedatives, and the use of oral appliances worn during sleep to keep the airways open by preventing the tongue and soft tissues in the back of the throat from collapsing. Several surgical options, which may be affective in certain individuals, also exist.

When I got my CPAP device, I was advised to be patient as the results would be gradual over a period of weeks. I have been using my CPAP for about a month, and my wife and I already notice a huge difference. I sleep much better now. So does my wife, now that I no longer keep her awake with my loud snoring. My alertness has increased, and my wife commented a couple of days ago how much perkier I seem these days.

Anyone who has reason to believe they might have sleep apnea should not hesitate to speak to a doctor. Knowledge is power, so arm yourself by doing lots of research-online and/or at the library-about the symptoms, consequences, and treatment options of obstructive sleep apnea. Obstructive sleep apnea is a serious disorder, which can be potentially life-threatening. But it can easily identified, and it can be treated effectively. The sooner you act, the sooner you can begin treatment.