Apnea - the not so silent killer
For at least 7 years my family had complained about my snoring. I tried the nasal strips, nose drops, raising my head while sleeping, losing weight, all of the popular ideas, but nothing helped. Apnea never crossed my mind until I found out my mother, who has always been thin, was diagnosed with the condition. Unfortunately she would never do anything about it and eventually died from fibrosis of the lungs, probably as a result of the untreated apnea (recent studies have shown a correlation).
In addition to my snoring I noticed that my HDL levels were well below normal. Even when I was exercising 40 minutes a day, in great shape, and eating right, the snoring continued and the HDL levels never rose. I would fall asleep at my desk at work, had headaches when I got up in the morning, and fell asleep watching TV in the evening. How or why I went to the doctor to see about a sleep test, I can't even remember but the test came back with a diagnosis of severe obstructive sleep apnea. After a second test I was prescribed a continuous flow CPAP machine.
The good news was that within a year my HDL levels rose to "normal". I had not changed my diet or exercise routine (was retired by then) so the only variable was the CPAP machine. The bad news was that from the first night I suffered from painful gas. It took over a year of research and working with my HMO to discover that because of my hiatal hernia (another study has shown that over half of apnea patients also have gastric problems) the continuous pressure CPAP just pumped me full of air every night. When I was finally able to get a auto titrating CPAP the gas problems stopped.
What I had was NOT aerophagia, which is a term ascribed to the condition by many doctors, but gastric insufflation, which can be very dangerous. The other, more insidious result of the bloating is that many straight CPAP users simply stop using their machines because they don't realize they can get relief from an auto machine.
Apnea is a killer. Google the internet and you will see that diabetes, stroke, heart problems, lung diseases, and hardening of the arteries are just some of the nasty things that can occur if apnea is not treated. The good thing is that if apnea is caught in time many of the problems can be headed off. In my case I hope that I found out soon enough to prevent the problems experienced by my mother, grandmother, and great aunt due to hardened arteries (as indicated by low HDL levels).
For many obese people, whose apnea is the result of their obesity, a "cure" is as simple as losing weight. Of course, if these folks also have the inherited factors (as I did) that lead to OSA (obstructive sleep anpea), losing weight may lessen the problem but will not cure it.
If you are always tired, have headaches in the morning, and snore (all people with apnea snore but not all people who snore have apnea), you may have apnea. Only a sleep test can confirm the diagnosis. The CPAP is not the only treatment but is 100% effective.
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Hello fritzgla -
Thanks for sharing your personal story and the impact this condition has had on your family. You seem to have done a lot to learn more about sleep apnea, which is a condition in which breathing is repeatedly interrupted during sleep. The time period for which the breathing stops or decreases is usually 10-30 seconds. When these episodes occur repeatedly, sleep apnea can seriously disrupt the quality of sleep.
Here's some additional information to assist you and other EmpowHer members who want to know more about this condition.
Take good care,
Pat
There are three types of respiratory events:
* Obstructive apnea—caused by a temporary, partial, or complete blockage of the airway
* Central apnea—caused by a temporary failure to make an effort to breathe
* Mixed apnea—combination of the first two types
Risk factors for sleep apnea include:
* Sex: male
* Overweight
* Age: middle to older age
* Family history of apnea
* Structural abnormalities of the nose, throat, or other part of the respiratory tract. Examples include:
o Polyps
o Severely enlarged tonsils
o Deviated nasal septum
* Hypothyroidism
* Medications: sedatives and sleeping aids
* Alcohol consumption
* Smoking
Sleep apnea symptoms include:
* Fatigue and sleepiness during waking hours
* Loud snoring
* Breathing that stops during the night (noticed by the partner)
* Repeated wakening at night
* Unrefreshing sleep
* Morning headaches
* Poor concentration or problems with memory
* Irritability or short temper
In addition, patients with chronic untreated sleep apnea may be at risk for motor vehicle accidents, depression , hypertension , and signs of heart disease.
An overnight sleep study (Polysomnography) is used to help diagnose sleep apnea. This test helps detect the presence and severity of sleep apnea. During sleep, it measures:
* Eye and muscle movements
* Brain activity ( electroencephalogram )
* Heart rate
* Breathing (pattern and depth)
* Percent saturation of your red blood cells with oxygen
In addition to sleep studies, doctors may perform:
* Blood tests (eg, to check thyroid function)
* Electrocardiogram
* Pulmonary function tests
There are a number of treatment options for sleep apnea, including:
Behavioral Therapy
* Lose weight if you are overweight.
* Avoid using sedatives, sleeping pills, alcohol, and nicotine, which tend to make the condition worse.
* Try sleeping on your side instead of your back.
* Place pillows strategically so you are as comfortable as possible.
* For daytime sleepiness, practice safety measures such as avoiding driving or operating potentially hazardous equipment.
Mechanical Therapy
Continuous positive airway pressure (CPAP) entails wearing a mask over your nose and/or mouth during sleep. An air blower forces enough constant and continuous air through your air passages to prevent the tissues from collapsing and blocking the airway. In some cases, dental appliances that help keep the tongue or jaw in a more forward position may help.
Surgery
In some cases, surgery may be recommended. Surgery can be used to:
* Remove excess soft tissue from the nose and/or throat
* Reposition the jawbone and tongue
* Create an opening in the windpipe for unobstructed breathing (in life-threatening cases)
Medications
Only used in central apnea, acetazolamide may help improve the ability to regulate breathing. A review of studies done on drug therapy for obstructive sleep apnea concluded that the evidence supporting use of medications was not adequate.
Supplemental oxygen may be given if blood levels of oxygen fall too low during sleep, even after opening the airway.
Prevention
You may be able to prevent the onset of sleep apnea by maintaining a healthy weight. Avoid alcohol, nicotine, and sedatives, which may contribute to airway obstruction.
RESOURCES:
American Academy of Sleep Medicine
http://www.sleepeducation.com/
American Sleep Apnea Association
http://www.sleepapnea.org
National Sleep Foundation
http://www.sleepfoundation.org
Thanks for filling in the blanks for others. My purpose was to hopefully wake potential apnea sufferers up to the fact that obesity and apnea are not always connected. You have provided the information they need to know what apnea is and how to treat it. Thanks!
Fritzgala
I couldn't agree with you more - while obesity is definitely a factor in sleep apnea in many cases, it's not in all. My husband has pretty severe sleep apnea and is not over-weight at all. If he is away, and doesn't have his C-PAP, he can tell the next day. People who snore or feel tired during the day, even when they think they're getting a good night's sleep- should be checked for sleep apnea. It's in no way a "fat thing" and we should all be aware of that.
Thanks so much for your share!
My husband snores, and at times I suspect sleep apnea. If he goes to his doctor, will the first line of testing be the sleep test? Is it pretty common for doctors to prescribe such a thing when someone's partner (me!!!) tells them that they snore too loudly and unevenly?
I would love it if someone who's had a sleep test would write about it in detail. Fritzgla, might you?
The site below has a "self-evaluation" that can be used as the first step toward diagnosis. The test results can be printed out and taken to the doctor. The fourth question may be the most important one. An apnea sufferer will have periods of snoring, then stop breathing and suddenly gasp or snort. Have you observed this with your husband? This is an apnea and should be reported to the doctor. As I said in my post, while not all snorers have apnea, all those with apnea snore.
You asked about the "first line of testing" - that is generally an interview to assess whether a sleep test is warranted. The doctor should ask many of the same questions (and probably more) shown in the "self-test". If a sleep test is warranted, it can often be done at home. The patient has a cannula (to determine the breathing pattern), sensors to monitor the heart, and a fingertip oxygen sensor. The results are examined to see if apnea is present with a AHI (apnea-hypopnea index) rating. If the results indicate a CPAP is required a second test will determine the settings.
The self-exam is found at http://www.sleepapneainfo.com/sleep-apnea_l2.php?id=91
Note that similar tests can also be found at other Internet sites. Hope this answers some of your questions.