Sleep apnea: ‘Wired up better than a computer network’
This article is not medical advice. If you have concerns, please consult your physician or medical professional. Names in the article have been changed for privacy.
The loud, rumbling snores are enough to wake anyone within earshot. Then the snores abruptly stop. A listener gets concerned as the seconds tick slowly by. Abruptly, the sleeper emits a clogged gasp. The snoring starts again. When the person wakes, they feel exhausted. The next night, the snoring erupts again. The serious condition of sleep apnea could be the issue. Lifestyle changes or a CPAP machine may solve the problem.
Also known as obstructive sleep apnea, the condition is indicated by short pauses in breathing when asleep. The breathing disorder is common and can happen to people of all ages. Both men and women suffer with sleep apnea, but it is more common in men. People may snore, but not all snorers have sleep apnea.
The cycle of obstructive sleep apnea begins with breathing easily as the sleeper relaxes. Loud snoring starts because the airway is partially blocked. A worsening blockage affects how much air reaches the lungs, and the sleeper’s oxygen level may drop. If oxygen levels drop during a sleep test from a partially blocked airway, doctors call the event “hypopnea,” reports the Canadian Lung Association (CLA). Next, the airway closes off completely.
No oxygen is breathed in, no carbon dioxide is breathed out. “Your brain is telling you to breathe as usual, but you can’t take a breath because your airway has closed off,” CLA says. After 10 to 30 seconds, or more, your brain senses the extra carbon dioxide in your blood system and kicks you awake enough to take a breath.
Upon taking a gasp or a snort of air, the person breathes again. At times, they may feel a choking sensation. The cycle occurs over and over again, taking the sleeper through “dozens or hundreds of sleep apnea events a night.” So many interruptions in sleep result in headaches and daytime sleepiness.
Physical problems cause sleep apnea. When throat, tongue and uvula muscles relax during sleep, the airway becomes partially blocked, “making breathing laboured and noisy and even stopping it altogether,” Cedars-Sinai Hospital Health Library (CSHL) says. Overweight people may have “an excess amount of tissue in the airway” causing narrowing of the throat.
High blood pressure may contribute to sleep apnea, and those who “have physical abnormality in the nose, throat or other parts of the upper airway,” CSHL states. The condition seems to occur in some families as well, suggesting a genetic connection.
Frequently unaware of their snoring, the person suffering with sleep apnea knows nothing of the events. Often a partner will mention it — including the aggravation from their own lack of sleep during ongoing disruptions.
Visiting a health-care provider is essential. Daytime sleepiness causes an increase in motor vehicle accidents, and sleep apnea “may be associated with irregular heartbeat, high blood pressure, heart attack and stroke,” CSH says. It may also increase depression and decrease sexual function.
The doctor may refer the patient to a sleep specialist. Investigations may include overnight testing at home or at a sleep laboratory.
Equipment may vary for taking readings for at-home testing, from a mask over the nose to a module on a wrist bracelet with a cable to a finger clip that connects to a smartphone app. Living in north central British Columbia, Callie’s specialist sent her home “with a machine that I attached to my one index finger for two nights in a row. It was no problem keeping it on at night,” she described, “and it didn’t bother me at all.” The innovative device measures oxygen saturation and pulse, sleep position, and apnea and hypoapnea events per hour. The information is easy to read in colour graph form.
Working in the Northwest Territories, Ted learned of his sleep problem from his girlfriend. She told him that he “stopped breathing quite often, and that my snoring was truly terrible.” After contacting his doctor, he waited several months for an appointment with a sleep specialist. “An overnight stay at their facility included being wired up better than a computer network,” he mentioned. “While awkward, it didn’t really affect my sleep while I was at the clinic.”
The treatment depends on the severity of the condition. Exercise, losing weight and stopping smoking may have positive effects. Avoid sleep medications or alcohol at bedtime. The substances — and some medications— may “make throat muscles relax more than normal,” Public Health Agency of Canada notes. “Alcohol and medications can also make it harder for your brain to ‘wake up’ and register a lack of oxygen in the body,” resulting in “longer and more serious pauses in breathing.” Setting a regular sleep schedule may help, and sleeping on your side instead of your back, so that tissues aren’t pulled down by gravity.
If your sleep apnea is more than mild or moderate, the sleep specialist may prescribe a “continuous positive airway pressure” machine, popularly known as a CPAP machine. Wearing a special mask — the basic type fits over the mouth and nose — the headgear is attached to the machine that “blows a steady stream of air through the mask, into your nose and down your throat (airway),” CLA describes. The stream of air “creates pressure, which holds the tissue in your airway open.” The patient’s throat stays open, and they can breathe steadily throughout the night.
The diagnosis was sleep apnea for Callie and Ted. Her breathing stopped “up to 16 times an hour, for about 30 seconds at a time,” she noted. Ted was recorded with breathing stopping 15 times per hour. CPAP machines were prescribed for both patients.
A more severe case developed when Moose spent the night at the polysomnographic laboratory in Kingston. His breathing stopped an alarming 63 times per hour. No wonder he was “always tired for no reason,” Moose said. He was a candidate for an urgent CPAP.
About the size of a standard box of tissues, a CPAP machine is light and portable. It comes with a padded case, electrical cord and humidifier tray. The device is quiet, “about as loud as raindrops or a whisper,” Cleveland Clinic says. The patient fills the humidifier tray with distilled water, and the machine’s breeze picks up the warm, humid air, delivering comfortable air that doesn’t dry out tender tissues. The CPAP machine is “incredibly effective in the treatment of sleep apnea” and “is often the first line of defence against the condition because it yields excellent results.”
In Ontario, a portion of CPAP costs may be paid through the Assistive Devices Program (ADP). The machine and supplies run approximately $2,000, including the mask (there are different styles to suit patient needs), filters and cleaning supplies. Masks should be replaced at regular intervals and are expensive, about $200 to $300 each. ADP does not cover the supplies.
Sleeping comfortably with their CPAP machines, Callie’s and Ted’s sleep apnea is down to less than once per hour; Callie uses hers during naps, too. Moose’s severe sleep apnea has been reduced to only 1.75 times per hour.
Treating sleep apnea is vital for health and safety. Callie noted that “I get much better sleep at night, and it improves my daily life with more energy.”
Susanna McLeod is writer living in Kingston.