Sleep apnea disorder poses risks, but is treatable By Darla Carter, The (Louisville, Ky.) Courier-JournalUpdated 11/18/2011 9:45 AM
Janet Purlee would wake up several times a night, gasping for air.
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Sleepiness and sluggishness would dog her during the day and darken her mood.
"I was very depressed because I just was so tired all the time, just extreme fatigue," said Purlee, 53, of Jeffersonville, Ind. "It was just a battle to stay awake during the day."
The married mother of two was also a severe snorer, whose nighttime rumblings would "wake the whole family."
It was "raise-the-roof kind of snoring," Purlee said.
A sleep study determined that Purlee was suffering from a severe case of obstructive sleep apnea. It's a condition in which people have trouble getting enough air into their lungs while they sleep, according to the National Heart, Lung, and Blood Institute.
The problem occurs when there's intermittent blocking of the upper airway, usually when the soft tissue in the rear of the throat collapses, causing a partial or complete closure, according to "Your Guide to Healthy Sleep," an NHLBI handbook.
As the person sleeps, his or her bed partner may hear interruptions in the person's snoring or what sounds like pauses in the person's breathing. These pauses may occur 20 to 30 times or more an hour, according to the guide. But the person with sleep apnea may have no awareness of what's going on.
They may simply report that "they're waking up not refreshed" in the morning, said Dr. Kenneth Anderson, a specialist in pulmonary and sleep medicine at the Baptist Hospital East Sleep Disorders Center.
Snoring and daytime sleepiness are among the most common symptoms, said Dr. William Lacy, a physician with Sleep Medicine Associates in Louisville.
"I have had people who have significant sleep apnea and their bed partners swear they don't snore, but that's fairly uncommon," said Lacy, who treats patients at the sleep center at Sts. Mary & Elizabeth Hospital.
In addition to the snoring nuisance, sleep apnea can lead to serious health consequences, ranging from car wrecks to cardiovascular issues, the doctors said.
For example, "severe sleep apnea increases your stroke risk three times over your normal risk," and it's "an independent cause of hypertension, so the cardiovascular risks are very important," said Anderson, a vice president and chief medical officer for Baptist Hospital East.
To treat her sleep apnea, Purlee, a patient at Baptist's Sleep Disorders Center, was told to begin using a continuous positive airway pressure machine, which requires patients to wear a mask while they sleep. The machine, referred to as CPAP, uses mild air pressure to keep the patient's airway open.
"Getting the diagnosis and getting on, at that time, CPAP was like a miracle in my life," said Purlee, who was diagnosed in 2002. "The CPAP machine has allowed me to get a full night's rest, without severe snoring and waking up gasping for air."
CPAP is just one of the treatments available to people who suffer from sleep apnea, which is one of the most common sleep disorders in the country.
An estimated 12 million to 18 million U.S. adults have sleep apnea, according to the sleep guide. Children can develop it, too, but may appear hyper rather than sleepy, Lacy said.
"Identifying obstructive sleep apnea in kids is very important," said Lacy, who said treatments for children include tonsillectomy and CPAP.
Identifying type
Most people who are diagnosed with sleep apnea have the type called obstructive sleep apnea.
"Your airway narrows more than it should and then your brain sort of senses this reduction in airflow and says, 'OK, I need air,' " so you will have multiple awakenings, said Lacy, who specializes in pulmonary and sleep medicine as well as critical care.
To diagnose sleep apnea, people are often asked to stay overnight at a sleep center to be studied. Various things are measured, such as heart rate, oxygen saturation, brainwaves, arousals and breathing movements, Lacy said.
With sleep apnea, there's "decreased flow of air but with continued or even increased effort in your chest and belly, so you're trying to breathe, and we can see that, but your airway is closed off or narrowed," Lacy said.
Of treatments included in a recent review for the Agency for Healthcare Research and Quality, CPAP had the strongest evidence to support its effectiveness for treatment of adults with obstructive sleep apnea. "It's absolutely the gold standard," because it's reliable and effective, Lacy said. "Your snoring goes away, all these arousals and interruptions of your sleep go away, you're able to fall into those deeper stages of sleep naturally, and generally, you wake up feeling refreshed and ready to go."
Other treatments
Alternatives include a mouthpiece called a mandibular advancement device, which can be very effective, according to the AHRQ report. Weight loss and surgical treatment also may help, but the evidence for them isn't as strong, the report notes.
"If you're heavy, weight loss should be part of your treatment no matter what treatment you get," Lacy said, but it may not end the problem. "Rarely will I see the person lose weight and get off their treatment; it's just so hard to do."
Purlee, a former occupational therapist, has an enlarged tongue that contributes to her sleep apnea. She also has multiple health problems, including a rare immune deficiency disorder that adds to her fatigue and daytime sleepiness.
After using CPAP for a while, she switched to a BiPAP (bilevel positive airway pressure) machine for extra help. BiPAP makes it more comfortable for patients to exhale, Anderson said.
Purlee also uses a bite guard, which she obtained from a dentist, to help her breathe better, and she takes medicine to treat daytime sleepiness.
Paul Markwell, 49, of Louisville was diagnosed with sleep apnea in May. The loan officer used to get up many times during the night to use the bathroom and relied heavily on caffeine and naps for energy. But he's noticed a big improvement in his symptoms since starting CPAP treatment.
Now, "I'm not waking up every two hours to go to the bathroom," said Markwell, who is one of Lacy's patients. "I don't need nearly as much coffee in the morning. I used to have to have a 15-minute nap every day when I came home. I don't need that anymore. €1/8 Now, I can stay up and watch Monday Night Football.
Janet Purlee would wake up several times a night, gasping for air.
Sponsored Links
Sleepiness and sluggishness would dog her during the day and darken her mood.
"I was very depressed because I just was so tired all the time, just extreme fatigue," said Purlee, 53, of Jeffersonville, Ind. "It was just a battle to stay awake during the day."
The married mother of two was also a severe snorer, whose nighttime rumblings would "wake the whole family."
It was "raise-the-roof kind of snoring," Purlee said.
A sleep study determined that Purlee was suffering from a severe case of obstructive sleep apnea. It's a condition in which people have trouble getting enough air into their lungs while they sleep, according to the National Heart, Lung, and Blood Institute.
The problem occurs when there's intermittent blocking of the upper airway, usually when the soft tissue in the rear of the throat collapses, causing a partial or complete closure, according to "Your Guide to Healthy Sleep," an NHLBI handbook.
As the person sleeps, his or her bed partner may hear interruptions in the person's snoring or what sounds like pauses in the person's breathing. These pauses may occur 20 to 30 times or more an hour, according to the guide. But the person with sleep apnea may have no awareness of what's going on.
They may simply report that "they're waking up not refreshed" in the morning, said Dr. Kenneth Anderson, a specialist in pulmonary and sleep medicine at the Baptist Hospital East Sleep Disorders Center.
Snoring and daytime sleepiness are among the most common symptoms, said Dr. William Lacy, a physician with Sleep Medicine Associates in Louisville.
"I have had people who have significant sleep apnea and their bed partners swear they don't snore, but that's fairly uncommon," said Lacy, who treats patients at the sleep center at Sts. Mary & Elizabeth Hospital.
In addition to the snoring nuisance, sleep apnea can lead to serious health consequences, ranging from car wrecks to cardiovascular issues, the doctors said.
For example, "severe sleep apnea increases your stroke risk three times over your normal risk," and it's "an independent cause of hypertension, so the cardiovascular risks are very important," said Anderson, a vice president and chief medical officer for Baptist Hospital East.
To treat her sleep apnea, Purlee, a patient at Baptist's Sleep Disorders Center, was told to begin using a continuous positive airway pressure machine, which requires patients to wear a mask while they sleep. The machine, referred to as CPAP, uses mild air pressure to keep the patient's airway open.
"Getting the diagnosis and getting on, at that time, CPAP was like a miracle in my life," said Purlee, who was diagnosed in 2002. "The CPAP machine has allowed me to get a full night's rest, without severe snoring and waking up gasping for air."
CPAP is just one of the treatments available to people who suffer from sleep apnea, which is one of the most common sleep disorders in the country.
An estimated 12 million to 18 million U.S. adults have sleep apnea, according to the sleep guide. Children can develop it, too, but may appear hyper rather than sleepy, Lacy said.
"Identifying obstructive sleep apnea in kids is very important," said Lacy, who said treatments for children include tonsillectomy and CPAP.
Identifying type
Most people who are diagnosed with sleep apnea have the type called obstructive sleep apnea.
"Your airway narrows more than it should and then your brain sort of senses this reduction in airflow and says, 'OK, I need air,' " so you will have multiple awakenings, said Lacy, who specializes in pulmonary and sleep medicine as well as critical care.
To diagnose sleep apnea, people are often asked to stay overnight at a sleep center to be studied. Various things are measured, such as heart rate, oxygen saturation, brainwaves, arousals and breathing movements, Lacy said.
With sleep apnea, there's "decreased flow of air but with continued or even increased effort in your chest and belly, so you're trying to breathe, and we can see that, but your airway is closed off or narrowed," Lacy said.
Of treatments included in a recent review for the Agency for Healthcare Research and Quality, CPAP had the strongest evidence to support its effectiveness for treatment of adults with obstructive sleep apnea. "It's absolutely the gold standard," because it's reliable and effective, Lacy said. "Your snoring goes away, all these arousals and interruptions of your sleep go away, you're able to fall into those deeper stages of sleep naturally, and generally, you wake up feeling refreshed and ready to go."
Other treatments
Alternatives include a mouthpiece called a mandibular advancement device, which can be very effective, according to the AHRQ report. Weight loss and surgical treatment also may help, but the evidence for them isn't as strong, the report notes.
"If you're heavy, weight loss should be part of your treatment no matter what treatment you get," Lacy said, but it may not end the problem. "Rarely will I see the person lose weight and get off their treatment; it's just so hard to do."
Purlee, a former occupational therapist, has an enlarged tongue that contributes to her sleep apnea. She also has multiple health problems, including a rare immune deficiency disorder that adds to her fatigue and daytime sleepiness.
After using CPAP for a while, she switched to a BiPAP (bilevel positive airway pressure) machine for extra help. BiPAP makes it more comfortable for patients to exhale, Anderson said.
Purlee also uses a bite guard, which she obtained from a dentist, to help her breathe better, and she takes medicine to treat daytime sleepiness.
Paul Markwell, 49, of Louisville was diagnosed with sleep apnea in May. The loan officer used to get up many times during the night to use the bathroom and relied heavily on caffeine and naps for energy. But he's noticed a big improvement in his symptoms since starting CPAP treatment.
Now, "I'm not waking up every two hours to go to the bathroom," said Markwell, who is one of Lacy's patients. "I don't need nearly as much coffee in the morning. I used to have to have a 15-minute nap every day when I came home. I don't need that anymore. €1/8 Now, I can stay up and watch Monday Night Football.
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