There is a good chance that you are not even aware that you are having sleep apnea. However, if it happens very often during the night, your life is in danger. I thought I was going to die. During the day, I felt so exhausted that my knees would shake. When I was behind the wheel, I sometimes found myself dozing off and falling asleep. Exhaustion was written all over my face. At night I slept in fragments, struggling to find a comfortable position for my legs, often waking up with my heart pounding and struggling to breathe. My doctor was puzzled. He ordered blood and urine tests and sent me for an electrocardiogram. Perhaps, he thought, the cause was heart disease, since I have such a rapid heartbeat at night. But no, my heart was fine. And the blood didn’t show anything. Then I was sent in for a colonoscopy.
All of this happened in 2008, and I was 47 years old at the time – an appropriate age for a first colonoscopy, one way or another. “But the gastroenterologist found nothing serious in me. No tumors. Not even polyps. But he did notice something. “When you were under anesthesia,” he said, “at some point you stopped breathing for a while. You need to get that checked – it could be apnea.” Apnea? I’ve never heard of it. It turns out that apnea is a cessation of breathing, in my case during sleep. Specialists distinguish between obstructive (narrowing of the upper airway during sleep) and central apnea. When the muscles of the larynx are too relaxed, they can block the airway. In sleep apnea, this can happen all the time, causing oxygen levels in the blood to drop. Then you wake up, gasping for air, desperately trying to open your mouth to breathe. This can happen dozens or even hundreds of times throughout the night, and the consequences for your health can be catastrophic. Apnea increases the workload on the heart, forcing it to work harder and faster as it tries to compensate for the lack of oxygen. The constantly changing level of oxygen in the blood leads to the formation of plaque in the arteries, increasing the risk of heart disease, high blood pressure, and stroke.
In the mid-1990s, the National Commission of the United States for the Study of Sleep Disorders determined that approximately 38,000 Americans die annually from heart disease aggravated by sleep apnea. There is growing evidence that sleep apnea affects glucose metabolism, leading to the development of insulin resistance (type 2 diabetes) and weight gain. Add to that constant fatigue from lack of sleep, which leads to memory problems, anxiety, and depression. A 2015 study in Sweden found that drivers with sleep apnea were 2.5 times more likely to be involved in an accident. People with sleep apnea also tend to skip work more often and are more likely to be fired.
Sleep apnea means you never get enough sleep. Another study found that people with severe sleep apnea were three times more likely to die over an 18-year period than people without the syndrome, all other things being equal. But (like smoking) people tend not to associate sleep apnea with such serious health consequences, according to a report by the American Academy of Sleep Medicine. The Academy estimates that 12% of Americans suffer from sleep apnea, but 80% of them are undiagnosed. Approximately the same percentage can be applied to the whole world: as a result, it turns out that about one billion people on the planet suffer from moderate and severe forms of sleep apnea (according to a 2019 study), without being aware of it and without receiving the necessary treatment.
I will talk about myself, about my experiences. Risk factors for developing sleep apnea can be obesity, certain body structures (such as a large neck, large tonsils, etc.), or aging. The problem, however, is that the syndrome does not manifest itself until a person falls asleep. So the only way to diagnose it is through sleep monitoring. That’s why in early 2009, on the advice of my doctor, I went to a sleep lab in Northbrook, Illinois. Sleep specialist Lisa Shives examined my throat and recommended that I undergo polysomnography, a test that monitors breathing, blood oxygen levels, heart rate, and muscle and brain activity. I returned to the lab a few weeks later at nine in the evening.
The only way to diagnose sleep apnea is to watch a person sleep. We explain quickly, simply, and clearly what happened, why it matters, and what happens next. эпизоды – Episodes End of story Promotional Podcasts The lab assistant led me into a small room with a bed. The equipment was in another room with a window behind the bed. I changed clothes and the lab assistant attached electrodes to my chest and head. Around 10 o’clock at night, I turned off the lights and fell asleep quickly. At half past four in the morning, I woke up and tried to go back to sleep, but I was told I had slept six hours and that was enough data. As I was getting dressed, the lab assistant told me that I had a severe form of sleep apnea and that Dr. Shives would give me the details. After receiving this news, I declined the planned breakfast and went home, quite scared. A few weeks later, I went back to Northbrook – this time during the day. Shyvs showed me a black and white video of me sleeping, and it was uncomfortable – like watching a crime scene where you’re being killed. As Shays told me, I once held my breath for a whopping 112 seconds – almost two minutes. Normal blood oxygen saturation ranges from 95% to 100%. In patients with acute chronic respiratory failure, it is usually higher than 80%. During my apneic episode, it was 69%. How dangerous is it? According to the WHO Surgeon’s Manual, if a patient’s blood oxygen level drops to 94% and below, it is necessary to immediately check for airway obstruction, lung failure, and circulatory problems. I had few options. According to Shays, I could undergo a uvulopalatopharyngoplasty, the essence of which was even more frightening than its name: it is an operation to remove tissue from the uvula, palate, and throat in order to widen my airway. The operation involves blood loss, and recovery is difficult and prolonged. As I understand it, Shays only suggested it to me in order to move immediately to the second option: a mask. When sleep apnea was first discovered, the only option for patients was a tracheostomy – the insertion of a tube through a hole in the throat to help them breathe. This provided relief, but it also had serious consequences. Today, a tracheostomy is only used in the most extreme cases. But just a decade ago…
The 2017 study found that sleep apnea affects nearly 40% of the German population. “I used to snore loudly when I slept and often woke up in the middle of the night struggling to breathe,” said Angela Kackler of Hot Springs, Arkansas, who was diagnosed with sleep apnea in 2008. In 2012, she was taken to the hospital with a heart attack, and in the morning the doctor said, “We’re going to do a tracheotomy on you.” More than seven years have passed – has she gotten used to living with a tube in her throat? “It’s a serious thing,” she says. “It requires regular cleaning, it’s like extra work. It’s uncomfortable. You don’t breathe like a normal person. Your throat gets dry all the time, you have to keep it moist. You’re at risk for various infections.” The biggest disadvantage for Angela is that she can no longer do her favorite sport, swimming. And she cannot stand people looking at her curiously. But her apnea is gone. “I don’t snore, I can breathe normally in my sleep now, I sleep better.
Although CPAP therapy is now considered the gold standard for treating sleep apnea, many who have tried it have been disappointed. Would she agree to such an operation again? “If such a question comes up again – yes, definitely. After all, it saved my life. And then Colin Sullivan, now a professor of medicine at the University of Sydney, invented the CPAP machine, which is now considered the gold standard for treating sleep apnea. The device, which includes a special mask, can be used at home. Millions of people use it today. However, it takes a lot of perseverance to achieve successful results. Although SIPAP devices are becoming more advanced (for example, their data can be uploaded directly to the cloud for further analysis), doctors have made an unpleasant discovery: this treatment often just doesn’t work. In the past, a patient could simply deceive the doctor and say that the mask was working perfectly. But now, with electronic data collection that instantly shows how much time the patient has slept with the mask on, doctors have discovered that many patients simply do not use it or take it off shortly after falling asleep because it is uncomfortable and disrupts sleep, according to a 2012 New York Times article. Research shows that between one-quarter and one-half of all users stop using CPAP within the first year. How it was done by me as well. The first night I tried the device, I slept well, even with this mask. This was done in a laboratory under medical supervision. But the positive effect of the first night quickly faded. I couldn’t experience the same thing at home. The thing is, the first letter “C” in CPAP stands for “continuous”. The machine delivers air continuously, even when you breathe out. You have to fight against this opposing airflow. I woke up choking. In addition, it was necessary to sleep with a mask that pressed against the face. The air leaked out from under the mask and dried out the eyes, even when they were closed. Most nights ended with me just taking the mask off. In the morning, I would check the statistics and see how little I had used the device. Dr. Shaivs tried to help me by adjusting the pressure of the supplied air and suggested trying different masks. I visited her lab several times, but it was all in vain. Finally, Shaiws said irritably, “You know, if you lose about 15 kilos, the problem will go away on its own.” In fact, obesity significantly increases the likelihood of developing sleep apnea. I am 180 cm tall and in 2009 I gained 95 kg (compared to 68 kg when I graduated from university). So at the beginning of 2010, I decided to lose as much weight as Shayv’s advised. And I almost succeeded: by the end of the year I weighed 80 kg. I got rid of my apnea and didn’t need a mask anymore.
“People with apnea risk undergoing surgery.” It turned out that I had won the battle, but not the war. Ten years later, the pounds slowly came back. And with them came the apnea syndrome. I didn’t realize this until I had spinal surgery in the summer of 2019. In the preoperative questionnaire there were questions about whether I snored during sleep, how often I get tired, and whether I had ever been diagnosed with “sleep apnea”. Yes, yes, and yes. It turns out that sleep apnea puts patients at risk during surgery and can affect their well-being and the likelihood of complications. According to a 2017 German study, up to 40% of the population in Germany may suffer from obstructive sleep apnea, and it is detected in only 1.8% of hospital patients. The authors of the study believe this is due to a lack of awareness of the problem among both patients and healthcare professionals. After admitting that I had been diagnosed with “sleep apnea” many years ago, I underwent extensive testing to determine the severity of my condition. The tests showed that I have moderate-severe apnea – possibly because I haven’t fully regained my previous weight. “Weight loss is beneficial,” notes Phillip Smith, a professor at the Johns Hopkins University School of Medicine who specializes in sleep apnea and pulmonary disease. “The only problem is that people are usually unable to do it.” Add to this the fact that many patients cannot use CPAP therapy, and there are very few options for getting rid of apnea. In the mid-1990s, for those who cannot tolerate a mask, a device was invented that goes into the mouth and causes the lower jaw and tongue to protrude forward [which can obstruct airflow during sleep apnea]. Like SIPAP, this device is not a perfect solution. It holds the jaw in an unnatural position, a person may feel uncomfortable, and prolonged use may alter the bite…
Since the mid-1990s, an oral appliance has been used to treat sleep apnea. Nevertheless, the majority of Dr. David Turak’s patients are quite satisfied with the results of using this device. According to him, it is suitable for patients with moderate sleep apnea. In severe cases, CPAP therapy is preferred. “I never offer freedom of choice,” he says. “I always say, try SIPAP first.” According to Turak, people who cannot tolerate oral appliances and CPAP masks can try surgery to improve the position of the jaw, which is much better than inserting a tube into the trachea. “Healing is easier and faster because it is a bone,” says Turk. However, it is still an unpleasant operation that involves breaking the lower jaw in two places. Another option for treating sleep apnea is sublingual nerve stimulation, which causes the tongue to contract and not recoil during sleep. According to Lawrence Epstein, M.D., associate director of medical affairs for the Sleep Disorders Service at Boston Women’s Hospital and recent chair of the American Academy of Sleep Medicine, CPAP therapy is still considered the gold standard, but in the end, treatment comes down to the best option for the patient. “We have very effective methods, but each has its drawbacks,” he says. “What is good for one patient is not necessarily good for another.”
Researchers hope to develop pills to treat sleep apnea, but this is unlikely to happen in the near future. Doctors have high hopes for tablets yet to be developed.
“The future belongs to neurochemistry,” says Professor Smith. “Probably in 10 years, or even five years, we will be able to treat sleep apnea with drugs because it is actually a neurochemical problem, not, say, a problem of obesity. Fats produce certain hormones that cause the airways to close. And there have already been some successes – for example, during the research, dronabinol, a semi-synthetic cannabinoid, reduced the severity of sleep apnea compared to placebo.
According to experts, CPAP treats the physical problem rather than its cause. Medications, on the other hand, act on the brain and nerves that control the function of the muscles in the upper airway. Other encouraging results include a small, placebo-controlled, international study of the effects of two drugs used in a specific combination (atomoxetine and oxybutynin) that significantly reduced the degree of apnea and eliminated obstructions to breathing during sleep by at least 50% in all participants.
But for people like me who currently suffer from sleep apnea, the wait may be too long. For me, it all means one thing: getting back on the diet and seeing a sleep specialist regularly. Significantly, when I tried to make an appointment with this specialist in July, I was told that the earliest available appointment was the end of October. A lot of people seem to have figured out what exactly is bothering them in their sleep.
Текст на русском языке: “У нас осталось только 10 свободных мест.”
Перевод на английский язык: “We only have 10 seats left.”
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