Sue Douglas would wake up choking and gasping for breath almost every night. In the morning, she would suffer from headaches and dry mouth and would be tired throughout the day.
The Miami resident had no idea she was suffering from sleep apnea — a common condition that affects millions of Americans — and likely had been for years. She now wonders whether that was what led to her congestive heart failure and open heart surgery in 2011.
“I saw my doctor and he put me in a sleep study and diagnosed me with severe sleep apnea,” said Douglas, 65, an insurance verifier at the University of Miami. “I think people need to be more educated about this. We need to get the word out that this can put strain on peoples’ hearts.”
Douglas now feels fine, thanks to nightly use of her “CPAP” (continuous positive air pressure) machine, an oxygen mask that is placed over the face and maintains a steady stream of oxygen to the body during sleep. The machine is the only treatment that is 100 percent effective for sleep apnea.
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Sleep apnea is a collapse or obstruction of the airway that causes sufferers to stop breathing in the night—in severe cases, hundreds of times. Like Douglas, they wake up gasping and choking for breath, or simply are fatigued all day because of the constant waking throughout the night. The condition affects roughly 7 percent of the population, with more cases for men than for women. Being overweight is a leading cause of sleep apnea, but not the only one. Your chances of developing the condition also increase after age 50. There is no known genetic component.
Sleep apnea is nothing to be taken lightly, says Dr. Alexandre Abreu, a sleep specialist with the University of Miami.
“You could die from this,” said Abreu. “How many people die from sleep apnea, we’ll never know. They just die in their sleep.”
In fact, NFL great Reggie White died from sleep apnea in 2004, at age 43. His wife started a foundation, The Reggie White Sleep Disorders Foundation, to raise awareness of the condition.
The condition can be especially serious for people who operate equipment or vehicles such as truck drivers, bus drivers, airline pilots, who Abreu feels should be routinely tested for sleep apnea.
Often, patients visit Abreu and other specialists because family members notice they are waking up gasping for breath in the middle of the night or snoring loudly (snoring may be an indiator). Physicians screen for the condition by asking patients such questions as whether they wake up choking and whether they are excessively sleepy during the day. They check the body mass index, as anything higher than 35 can be a potential indicator, as well as neck circumference. For men, a circumference greater than 17 inches, and for women, a circumference greater than 16 inches, are possible indications of sleep apnea.
If the signs point to a potential sleep apnea diagnosis, doctors then refer patients for a sleep study. For the study, patients sleep in a hospital lab overnight, where technicians monitor their slumber. The study may involve electrodes attached to the head, a heart monitor, a microphone taped to the neck, a plastic tube inserted into the nose to measure oxygen and other devices to monitor sleep levels .
The test records several body functions during sleep, including brain activity, eye movement, oxygen and carbon dioxide blood levels, heart rate and rhythm, breathing rate and rhythm, the flow of air through your mouth and nose, snoring, body muscle movements, and chest and belly. It positively confirms a diagnosis of sleep apnea.
Doctors recommend patients lose weight, but this is not always easy for the patient, nor is it 100 percent effective, notes Dr. Belen Esparis, medical director of Mount Sinai Medical Center's Sleep Disorders Center and Laboratory in Coral Gables. “I have skinny patients who have sleep apnea,” she said.
The “gold standard” treatment for sleep apnea is the CPAP machine. Unfortunately, many patients resist the treatment, finding it uncomfortable or unattractive to a partner or impractical for frequent travel.
“Not everyone likes it or wants to use it,” said Esparis. “But it’s the best treatment for sleep apnea. All other treatments are second line treatments.”
Douglas says it’s a matter of getting used to the machine. At first, she said, “it felt strange.” But now, she says, “it’s like second nature to put it on when I go to bed.”
Those second-line treatments include surgery by an ear nose and throat surgeon, who removes a small piece of the soft palate in the back of the throat. That tissue can obstruct breathing during sleep. The procedure is 40 percent effective.
Another alternative treatment, called a mandibular advancement device, involves attaching a dental prosthesis to the upper and lower teeth. The device works by moving the tongue forward, to keep it from obstructing the airway. That treatment is also about 40 percent effective, and is more effective with mild sleep apnea, doctors say. The advantage: it’s less invasive than surgery.
There is currently no drug available to treat sleep apnea. “The person who comes up with that will make a lot of money,” said Esparis. “They’re working on it.”
Doctors treating sleep apnea say there is hope on the horizon. The FDA recently approved a new treatment for sleep apnea that involves inserting a pacemaker-like device in the chest wall. The device sends an impulse to the nerve that controls the tongue and moves the tongue away, opening the airway. So far, just 127 people have undergone the procedure in the United States and Europe.
Dr. Rolando Molina, an otolaryngologist and sleep specialist at Baptist Hospital, said he is screening patients for the procedure, which is offered only when CPAP fails. So far, he has not been able to get approval for the surgery from insurance companies but is appealing their decisions.
"We are trying to get over some hurdles, but for the first time we have a surgical option that cures sleep apnea," Molina said. "There's a lot of hope and excitement in the sleep apnea community."
Another sleep-related condition that doctors treat is sleepwalking, which is common in children but rare in adults. “When you get older, you outgrow sleepwalking and sleep talking,” notes Abreu, who added that sleepwalking sometimes goes hand in hand with sleep apnea. When the sleep apnea is treated, the sleepwalking may go away.
Doctors warn the condition can be dangerous, particularly for those who live in high-rises or in cold climates. Several years ago, a young boy died in Philadelphia after sleepwalking outside and winding up in the garden in the winter. He died of hypothermia.
Abreu had a patient who faced eviction after sleepwalking naked in the hallway of his condo. After Abreu wrote a letter to the board explaining his condition, they let him stay.
Abreu treated the man successfully with a small amount of a sedative before bed, and cautioned him not to go to bed too late. “We only give medication when it’s severe,” he said.
Doctors consider the patient’s surroundings when deciding whether to treat a case of sleepwalking.
“What we worry about is if you are a sleepwalking person, are you a danger to yourself,” he said. “If you sleepwalk and just walk around your bed, is it really a big deal? But if you live in a high-rise and sleepwalk … you need to put bars on the window and alarms on the door. They may open the door and all of sudden they are in the middle of the street, they are on Calle Ocho and get run over by a car.”
Esparis, too, had a patient whose sleepwalking was putting her in danger. She lived on the 23rd floor of a condominium, and her husband repeatedly found her sleepwalking to the balcony. In such cases, doctors advise patients to put locks and security alarms on doors to wake sleepwalking patients or warn their spouses.
• UHealth Sleep Center, 305-243-ZZZZ (9999)
• Mount Sinai Medical Center Sleep Disorders, 305-604-2923.