“I was driving along a state highway heading home on a summer afternoon. I dozed and drifted onto the gravel shoulder toward a drop-off onto someone’s lawn. The bang of my right side mirror striking a mailbox woke me up. I swerved left and skidded back into the road. Safe this time, but frightened.”
Dan was often sleepy during the day. He decided to see his doctor and told him about his near miss and some other things that had been happening lately.
- He fell asleep at night the moment he put his head on the pillow.
- Sometimes he’d wake with a start during the middle of the night.
- Many mornings he woke up tired.
- He’d often think about grabbing a nap during the day.
- He’d doze off while reading or watching TV, in waiting rooms and sometimes, during phone conversations.
- His wife often woke him up and told him to stop sleeping on his back because he was snoring.
Dan’s doctor referred him to a lung specialist, who noticed a few other things. Dan was over 65, he was overweight and had a thick neck. He doesn’t drink or smoke and exercises regularly, but he had enough symptoms to warrant an overnight test at a sleep lab.
“My job was to sleep as usual,” he says. “The technician attached leads all over my head and body. We talked about the Red Sox as I watching part of the game on the TV. Disappointed in our team, I lay down and went to sleep. The leads and lines bothered a little, but I could still sleep. The lab’s equipment measured every little thing overnight, including how many times and when I stopped breathing, how soundly I slept, how much I had slept on either side and my back, and what went on with my heart.”
The diagnosis? Sleep apnea.
If you have apnea, your breathing stops and starts all through the night. It can be serious. There are three main types of sleep apnea.
Obstructive sleep apnea
Happens when throat muscles relax. It’s the most common type of sleep apnea. For a variety of reasons (see risk factors below), the muscles can relax as you breathe in and narrow or close your airway. If you can’t get your breath, the oxygen level in your blood may lower. The brain realizes what’s going on and wakes you up so you can breathe. It can happen many times all night long and when it does, you may snort or gasp. You might not remember a thing in the morning, but your body will not have had a good night’s sleep.
Central sleep apnea
Happens when the brain sends the wrong signals to the muscles that control breathing. That means your body doesn’t even try to breathe for a short period of time.
Complex sleep apnea syndrome
A combination of obstructive and central sleep apnea.
Sleep apnea risk factors
A few months ago, I attended a presentation called Healthy Sleep Matters! The Lifeline Center for Workplace Wellness sponsored the event. Respiratory therapist Martine Eon, who is a clinical lung specialist at MaineHealth and works on special projects at the Maine Sleep Institute, was the guest speaker.
Martine says that between three and seven percent of the population in the United States have the more common obstructive sleep apnea. She lists a number of risk factors.
- Age (muscle tone decreases with age)
- Being male (Men are twice as likely to have it than women)
- Family history
- Head or facial abnormalities
- Thick neck. A thick neck may mean a narrower airway
Sleep apnea symptoms (all types)
All the things that Dan had been experiencing were common symptoms of sleep apnea.
- Falling asleep immediately because you’re sleep deprived
- Feeling tired when you first wake up and drowsy throughout the day
- Gasping, choking sensation that wakes you from sleep
- Snoring (usually more common with obstructive sleep apnea)
- Sleeping partner witnesses that you sometimes stop breathing and then snort or gasp while still sleeping
- Difficulty staying asleep
- Waking up with a dry mouth or a sore throat
- Having a morning headache
Treating sleep apnea
Sometimes, all that’s needed to treat mild obstructive sleep apnea is to make a few lifestyle changes.
- Lose extra weight
- Quit smoking
- Avoid alcohol and medications that may relax muscles in the back of the throat
- Get regular exercise
Dan uses a CPAP (continuous positive air pressure) machine all night every night. It can be used to treat obstructive and central sleep apnea.
“I use a little mask with a cushion over my nose to accept some lightly pressured regular air that keeps my airways open. I also record my sleeping experience — breathing, hours asleep, etc — on a card attached to the machine.
If the CPAP doesn’t work, other devices are also available. Some cases of sleep apnea have to be treated surgically.
Dan has been using his CPAP machine every night for more than a year.
“I don’t breathe through my mouth at night any more. I don’t snore. I don’t wake up startled at night. I usually don’t wake up tired in the morning. I don’t crave a nap every day. I don’t doze off like I used to. I am more attentive, more energetic, and less crabby during the day.”
He recently got proof that if doesn’t use the machine, he’s right back where he started.
“I made the mistake of not preordering some of the equipment that needs regular replacement. I went a week without using the machine. I woke up each morning feeling I wanted to go back to bed. I was fuzzy-headed and grumpy. I had not slept without it for more than one or two nights since starting over a year ago. Going back to positive pressure breathing has done wonders for my mood, clarity, and alertness.”
If you suspect you might have sleep apnea, it’s important to get it checked out. Like Dan, you may need to see a sleep specialist and have a sleep study to get a proper diagnosis.
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