It's not uncommon to find that a spouse or girlfriend is behind a man's visit to a doctor to address specific health concerns, and that is especially true when it comes to sleep apnea. "About 75 percent of the time we hear, 'My wife says I snore and stop breathing, but I don't think I have a problem,'" says Patricia Patterson, MD, FCCP, medical director of the St. Vincent's Sleep Center.
"The wives are usually right," she adds.
Apnea occurs when air doesn't adequately exchange into the lungs due to a mechanical obstruction in the airway. The brain senses an elevation of carbon dioxide and reduction of oxygen, sends a signal and tightens up the airway, causing breathing to stop. Multiple sleep disruptions result, leaving a patient fatigued, even if he thinks he's had ample sleep. Many people with sleep apnea snore, which is one reason that spouses urge medical intervention.
During an overnight sleep study, the patient is monitored for EEG, ocular EMGs, airflow, snoring, arm and leg movements, chest and abdomen movements, EKG and oxygen levels. In some cases it can take two nights to successfully complete the sleep study, but most take only one night. "A majority of the time, we can initiate the study and diagnose apnea within the first two hours," explains Patterson. "Then we begin to initiate therapy."
Therapy most often requires a Continuous Positive Airway Pressure, or CPAP, machine. A bi-level PAP sometimes works better. The machines have improved considerably, Patterson says. "We have innumerable masks, much better than they have been in the last five or six years. We have nasal masks, masks that fit over the nose and mouth, and nasal pillows, which only go in the nostrils. We even have a new apparatus called nasal air, similar to oxygen tubing, which is particularly effective for claustrophobic patients."
Newer machines also include humidifiers and heaters, and whereas noise used to be a "huge problem," they are much quieter today.
There are surgical treatments for apnea, which have been particularly effective for younger patients, but most find the CPAP machines to bring the necessary relief.
Patterson stresses the importance of diagnosing and treating apnea. There's more at stake than a good night's sleep. "There can be big problems, including cardiovascular disease, worsening hypertension, increased risk of stroke and depression. There are a lot of sexual side effects. And there's also a potential for reduction in intellect." Patients suffering from morning headaches, high blood pressure, or a history of stroke, TIAs, or atrial fibrillation may need to be referred to a sleep clinic. "The younger people who have it have more to lose," she points out.
