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It’s time for a new occasional feature! Rejoice! In this column, I’ll talk about my personal experience being diagnosed with sleep apnea, what treatments are available, the science behind the condition, and (hopefully) my miraculous improvement after being treated. For this first entry, I’ll talk about the experience leading up to my sleep study. In future columns I’ll reveal the diagnosis and treatment, and you can follow along as I try to catch some sleep. Before we begin the narrative, let’s get a quick definition of “sleep apnea” from Wikipedia (slightly edited for clarity by me):
Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. Each episode, called an apnea, lasts long enough so that one or more breaths are missed, and such episodes occur repeatedly throughout sleep. The standard definition of any apneic event includes a minimum 10 second interval between breaths, with either a neurological arousal, a blood oxygen desaturation of 3-4% or greater, or both arousal and desaturation. Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, or a “Sleep Study” which is often conducted by a pulmonologist.
…the individual with sleep apnea is rarely aware of having difficulty breathing, even upon awakening. Sleep apnea is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body. Symptoms may be present for years (or even decades) without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance.
My sleep problems started probably ten years ago, during college, when I became aware that my snoring was really loud. And let me dwell on this a moment — we’re talking sawing logs with industrial machinery loud. The term “epic” was used to characterize my snoring, and neighbors in my college apartment building actually complained. I tried using several nose-opening devices, nasal sprays (disgusting!), sleeping with my mouth closed, and different sleeping positions, but nothing seemed to help. Eventually I ended up in a corner apartment where my neighbors couldn’t hear me: problem solved?
Rewinding a few years…at some point during my teenage years, my father had been diagnosed with obstructive sleep apnea. He and I have very similar body types, including a predisposition for charming plumpness as well as a relatively narrow airway in the throat. I have a small mouth (at least relative to my neck), and I still have my tonsils. So it stood to reason that I might develop obstructive sleep apnea as well.
In the time since my snoring became an issue and my recent diagnosis, I really didn’t do anything about my sleep problems. I’ve always been a very sleep-positive person, often sleeping in until noon (and beyond) on weekends. Over the last year or two, I found myself even sleepier: spending entire weekend days asleep, and ultimately not feeling refreshed. Something was wrong. I went to my doctor, who did a bunch of blood tests and ultimately referred me to the Sleep Disorders Program at a local medical institution.
The sleep specialist had me fill out extensive questionnaires about my sleep history and habits, and did some physical tests and a complete interview before prescribing a sleep study. Now, let me back up a little bit here: I actually had a sleep study before. Three years ago, in a similar bout of sleeplessness, I had been sent off to a somewhat lower-rent sleep clinic for a study (which was not preceded by a consultation with a sleep specialist). That experience was a disaster: I spent the night covered in wires and surgical tape, vaguely panicked, and ultimately unable to sleep. After ten hours, they finally discharged me without having slept at all. The study was inconclusive, and my insurance paid handsomely for the ordeal. So when I was prescribed another sleep study, I was wary. Well, let’s just say it: I hated the idea. The previous study was awful, lying in the dark for ten hours struggling to sleep while connected to various machines, occasionally being interrupted by lab techs over a speaker asking me why I wasn’t sleeping. I didn’t want to go through that again to end up with nothing.
This time, things would be different, the sleep specialist said. For one thing, the new sleep study would be carried out in a modified hotel suite, rather than a hospital room. In the new study, I was encouraged to bring my own pillows from home (this actually was a real problem at the old study — their pillows were awful). For another thing, my doctor prescribed Ambien as a sleep aid during the study, and suggested I get used to taking it prior to that night. Finally, being aware of my previous experience, the staff was extra-nice and accommodated my one odd request: I wanted the room to be as cold as possible, to get as close to my home situation as possible. (I sleep in a fortress of solitude in the frozen North.) With the air conditioning set at 64, I was all set.
Next entry: I’ll talk about the sleep study — what was involved, what they were looking for, and how it went. Do you have sleep apnea? Share your experiences in the comments!
(Image courtesy of American Academy of Family Physicians.)
Comments (31)
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I have sleep apnea. I had it for years before I had a sleep study. In 2000 I finally became sick enough to check into the ER to find out why I was so sick most of the time. They discovered that I had had a silent heart attack 2 years before that and I was now in heart failure. The doctor wanted me to have a sleep test as part of the treatment. I went in and had all those wires and sensors attached to me. Turns out that I stopped breathing more than 10 times a minute while sleeping. This lack of sleep caused many problems in my life; I would fall asleep while driving (several times but never resulted in an accident), I fell asleep while at work and I would snore so badly the neighbors 3 blocks away complained.
I received a CPAP machine after the study. (Constant Positive Air Pressure)
What a change it made in my life. I don’t fall asleep during the day, I am more alert and I don’t wake the neighbors.
I hope you have the same results as I did.
posted by Owen on 9-26-2008 at 6:21 pm
My dad has a pretty bad case of sleep apnea. He did the whole sleep study thing too. The doctors first had him try a C-pap machine. It forces air into your lungs by way of a mask, tube, and machine. Pretty much he looked like Darth Vadar at night. But he found that he would take if off at night while he was sleeping and that he couldn’t sleep well with it.
Over the course of the next few years, he had 3 surgeries. 1. He had his tonsils and some tissue from his throat removed. Didn’t help. 2. He had tissue from his sinuses, nasal cavity, and more from his throat removed. Didn’t help. 3. He has a skew put into the base of his tongue and had his tongue wired forward. Did nothing.
A few years later he found out about a doctor in our area that had created a special mouth guard that was designed to fit both the top and bottom teeth that hooked together in the front. The hooked part is then screwed forward to keep this jaw forward and tongue from falling back and blocking his airway. He’s used it now for several years and loves it. It was was relatively inexpensive (especially compared to three surgeries).
If you would like to know more about this mouth guard, feel free to email me and I can get the info to you. Good luck!
posted by Amy on 9-26-2008 at 6:29 pm
First off, Amy, I would love to know more about that mouth guard! Second, not only do I have obstructive sleep apnea (a mild case), I suffer from bruxism (severe grinding of the teeth during sleep). When the neorologist reviewed my sleep study she said she believes that a severe case of insomnia and the bruxism are contributing to the mild sleep apnea and my constant exhaustion. Then I got a sinus infection and it wouldn’t go away so I had to go for a ct scan and they found that my septum was severly deviated and nothing could escape, the deviation was also causing my migraines (that I had been dealing with for over 15 years). I had a septoplasty and a ballon sinoplasty (could be wrong on the spelling of that one) done in August this year and since then I’m feeling awesome! I have the energy I had in my pre-teen years and with the way our medical practices are today, I highly recommend you just keep asking why. I was diagnosed with bipolar disorder, you name it and every time I went to my doctor with a complaint he just blew it off like I was just crazy and lazy. Also, one of the most major side affects of having sleep apnea is high blood pressure. If your not suffering from it, keep looking for an answer.
posted by Maria on 9-26-2008 at 6:45 pm
My husband has sleep apnea; newlywed life was NOT fun as he also had epic snoring. He’s been on a CPAP for 6 years now and life is 100% better for both of us. My one piece of advice is that if you get a CPAP, it can feel a little claustrophobic at first – don’t panic. I stayed up and watched him fall asleep the first couple of nights and was there awake and alert if he got panicked and would take the mask off for a short while. Ultimately, by using the ramp setting, the panic really only lasted that first day. By day 2 he was sleeping soundly all night. Also, the doc gave him an oxygen compressor to use with it and I totally love the white noise sound it makes – helps me sleep. Double bonus: he lost a chunk of weight right after going on the machine just from getting enough sleep and oxygen. Double plus bonus: fun impersonations of Darth Vader while wearing the mask. Good luck and don’t give up on the CPAP – it really is scarier than it looks and it definitely saved my husband’s life and our marriage.
posted by Val on 9-26-2008 at 7:24 pm
Oops should have said “it really looks scarier than it is”. Sorry!
posted by Val on 9-26-2008 at 7:26 pm
My dad also has sleep apnea and had all of those symptoms: heavy build, massive fatigue (he would take afternoon naps on the couch during which you couldn’t hear the TV in the same room), and the epic snoring (the tech who ran his sleep study said he was the loudest she had ever heard–and was skeptical that his wife sleeps in the same room as him). He got a CPAP and after he got used to it, grew to love it. Yup, he looks like Darth Vader or a fighter pilot, but he’s not falling asleep on the road anymore and it’s refreshingly quiet at night at my parents’ house. Oh yeah, and those trips up to the family cabin are more pleasant for everyone involved. He got a car battery and rigged it up to his CPAP so he can be portable AND breathe.
posted by Fruppi on 9-26-2008 at 7:44 pm
I was diagnosed in May of this year. The last two years have been hell. Migraines, cranky all the time, depressed… Now with the CPAP I’ve been sleeping for just over three months now. What a difference!
simplyodd.com/blog/2008/05/02/i-suck-at-sleep/
posted by Chuck on 9-26-2008 at 8:08 pm
This is a great topic, and I’m glad you’re doing a series about it. My husband was diagnosed a year ago, went through the sleep study, and got a CPAP machine. His snoring was SO BAD, and now things are much improved, although not completely cured. He still snores sometimes even when using the machine. I’m jealous of all the people I talk to and read about who say the CPAP cured all their problems! (But happy for them too).
Chuck, it’s interesting that you mentioned having suffered from migraines. My hubby had them all the time too, and since getting his sleep apnea treated I don’t think he’s had one. It never occurred to me that the migraines might have been caused by his sleep problems, but it certainly makes sense.
posted by Michigan Mom on 9-26-2008 at 8:32 pm
Getting a sleep study done, going on CPAP, and smoking cessation (all about two years ago) were life-changers. If I’d known I’d feel this good as a result I’d have done these things years ago.
I was having 90 apneic events per hour – one every 45 seconds…
posted by mechmike on 9-26-2008 at 9:01 pm
I’ve had two sleep studies. The first one, I barely slept because my neighbor in the room next to me had seizures all night that kept waking me up (thrashing so hard he was banging the headboard of the bed into the wall).
The second (at a different location) determined I was fine and have no sleep disorders. I didn’t really expect to have sleep apnea, even though my mom does (neither of us is overweight, and we’ve both had our tonsils out, but she snores and I don’t). However, I admit I was slightly disappointed to have been found to have nothing, because I still can’t wake up in the morning, can easily sleep 15 hours at a stretch, never feel rested, take “30 minute” naps that accidentally turn into 6 hours, have chronic migraines, depression, etc. Blah! I have zero desire for a CPAP, but I want to be able to wake up, stay awake all day, and have some energy for once!
Sorry, didn’t mean for that to sound so sobby. I’m really glad for all the people that CPAP has helped, I just wish I could find a way to get those results to solve the problem I supposedly don’t have.
posted by Celeste M. on 9-26-2008 at 11:31 pm
I was just diagnosed with acute sleep apnea. My AHI (see Wikipedia) is 119. Like Chris, I was sawing wood with a 48″ chainsaw since college. I got my CPAP device a week ago. It has made a tremendous difference. Besides getting a recuperative night’s sleep, not snoring anymore, and actually getting up when the alarm clock goes off there are other benefits. My blood pressure (both systolic and diastolic) has dropped about 10 points. I was having muscle problems including muscle spasms and a painful, persistent “knot” in my left shoulder blade. Those are gone. [It turns out the during REM sleep your brain paralyzes your muscles so that you don't act out your dreams. When you stop breathing (due, for example to apnea) your brain wakes you up and enables your muscles so you can deal with the problem. My muscles were never relaxing and repairing during sleep.] My general mood is better now too. I look forward to more benefits (including, hopefully, weight loss) as I continue with the CPAP.
My CPAP pressure is 14. The first night with that pressure was a little weird but now, a week later, I don’t even notice it. I don’t have any problem turning from side to side during my sleep either. The only thing I am struggling with a little is the comfort of the mask; I have a mask that covers both my nose and mouth because though I start out breathing through my nose, I do also breathe through my mouth while sleeping. There are many styles and sizes of masks so I’m sure I’ll work through those issues.
My only regret is that I didn’t get myself diagnosed sooner.
Good luck Chris and to everyone else.
posted by Neil on 9-26-2008 at 11:40 pm
I’ve had a CPAP machine for 4 years after being diagnosed with medium-severe sleep apnea.
I agree with everyone who has said that CPAP machines are the best solution – they take a bit of getting used to but are worth sticking with. Ideally you get the CPAP machine via a established and reputable sleep unit which can help you getting used to the machine.
Mouth pieces only work for people with mild SA — medium or severe cases need CPAP. Keep in mind that companies selling mouth-pieces will overstate their usefulness – which is understandable given the high prices they charge. If you do go for a mouth-guard – it has to be fitted by a dentist specially qualified to do so.
Surgery looks appealing but, as one person has already discovered, the failure rate is high. Something that less honest surgeons will gloss over.
The most important comment to make is the unfair demonisation of CPAP machines. Some of the anti-CPAP remarks come from people who have had bad experiences and/or no support in the early days of use. Much of the bad press for CPAP comes from companies selling alternatives – they have a vested interest in grossly overstating the bad sides of CPAP.
Modern CPAP machines are quiet (’white noise’ at worst), the masks far more comfortable than they look. Chin-straps are needed at first but you may be able to train yourself not to need it.
Researching sleep apnea on the web can be difficult because you have to sort out the companies selling ‘cures’ of dubious repute from genuine, qualified experts.
Much of what you read on the web comes from people who could kindly be described as ’snake oil salesmen’.
So this series on Mental Floss is a welcome intro to the matter.
posted by Peter Deegan on 9-27-2008 at 12:49 am
I am going to to have a sleep study scheduled soon as I have been told that “You snore like a beast that is not of this Earth!” I am anxious about the concept of being observed or monitored. I have issues with sleep patterns as well(insomnia, hypersomnia, nights and days turned around in a never ending cycle). I look forward to keeping up with this blog.
posted by Michael Shields on 9-27-2008 at 1:45 am
Celeste–
My younger brother was having sleep problems similar to yours–he wired up an alarm clock to go off in a different room with speakers in his so he would have to leave the room to shut them off…and then subsequently pulled the wires right out of the wall a few mornings later. He started taking a melatonin supplement and has felt 100% better.
posted by Fruppi on 9-27-2008 at 6:45 am
Amy – please email me the information ASAP. bzzzx2@frontiernet.net.
My husband cannot use the CPAP because it gives him headaches and has had two surgeries removing tonsils, adnoids, uvula, and other tissue in his throat. He has a 45 minute drive to work and has to often pull over and sleep because he is falling asleep while driving. I am constantly worried about his health and about him killing himself or someone else on the road.
posted by bzzyb on 9-27-2008 at 9:09 am
I was diagnosed with sleep apnea this past June. I got a CPAP Machine which has been wonderful. A nice side benefit is I lost 12 pounds in 3 months from finally getting enough rest. My wife loves it since I’m not tired all the time and the white noise helps her sleep.
I later found that almost all my male friends of my age have one. Is this mostly a male phenomenon? I don’t know any women who have to use one.
posted by cainmark on 9-27-2008 at 9:34 am
After ten years of first-gentle then insistent prodding, my husband finally had a sleep study done where they found he stopped breathing 40+ times a minute. I used to hate hearing him wake up in the middle of the night, gasping and sputtering. It’s scary for BOTH people.
He tells everyone he meets how he’s glad he *finally* listened to me, because he’s sleeping more soundly and is more refreshed and energetic. A couple of times (travel, power outage) he hasn’t had the use of the machine and is quite distressed about how poorly he sleeps.
The ironic thing is that *I* am the one with the snoring problem. So now our roles are reversed… he’s nagging, and I’m resistant.
posted by Amanda M. on 9-27-2008 at 10:26 am
Not to make too light of a serious condition, but does the illustration remind anyone else of the classic Alfred Hitchcock profile?
posted by Emily on 9-27-2008 at 10:50 am
In hindsight, one thing that troubles me about my own experience with OSA is how the first doctors I saw were reluctant to help me get treatment.
The first doctor agreed that I could have OSA but suggested attaching a tennis ball to the back of a t-shirt to prevent sleeping on my back (after I told him that it didn’t matter what body position I slept in). He also suggested that CPAP devices would be too much trouble and that I wouldn’t want to use one.
Another doctor was skeptical despite my having almost all of the classic symptoms but fortunately I was able to refer myself to a pulmonologist and get a sleep study.
With OSA being such a common condition I would think G.P.s would be better trained in diagnosis and the benefits of treatment.
posted by DougJ on 9-27-2008 at 11:05 am
I have sleep apnea, but I am completely the opposite of the typical profile. I’m female, 29 years old, weigh 120 pounds, and hardly ever snored. However, my dad has it too, so in my case it’s genetic.
One thing I haven’t seen mentioned in any of the comments is hot flashes. Ever since I was a teenager I would have major hot flashes in the night, and sometimes wake up feeling hot and sweaty for no reason, even in a cold room in the dead of winter. Once I started using the CPAP it completely stopped. My doctor told me that hot flashes are a symptom of sleep apnea, because the body temperature goes up when it’s not getting any oxygen. Did anyone else have this?
posted by Jaclyn McKewan on 9-27-2008 at 11:36 am
Fruppi: Yeah, I’ve tried melatonin. Trust me, I’ve tried pretty much everything. But thank you! =)
posted by Celeste M. on 9-28-2008 at 2:10 am
I’ve been on CPAP for about 6 months, and can honestly say it changed my life. Super Important: You need to address leakage issues with your mask !! If your mask leaks, pressure settings will be too high, causing burst blood vessels in the eyes, ear and sinus infections, and other discomforts. One key, masks with “replaceable” seals are a complete scam, costly and inefficient. Look for one-piece mask, like the ComfortFull2, which I swear buy.
Ideally, you want the lowest pressure possible tht still keeps your AHI (hourly apnea episodes) to less than 5. If you are at 1 or 2, you can probably lower the pressure even a little more.
When all is sealed well, I use a setting of 13, ramped up from 10. My doctor had me at 17 initially to allow for leakage (NOT a good solution, FIX the leakage), causing me bloodshot eyes, earaches/blockage, sinus discomfort, etc.
Also, for those that don’t want to go to the doctor to make adjustments (or can’t), look up the clinician’s manual for your machine, adjust yourself (carefully).
posted by scott on 9-28-2008 at 12:25 pm
I am a chronic snorer. I snored (loudly) pretty much from adolescence on. At home, no one noticed it, because both my brothers and my father snored tremendously. (I remember as a child being comforted by hearing my father snore.)
I have always felt like I couldn’t concentrate, had trouble getting up in the morning (even with multiple alarm clocks), and driving to work was always a challenge. (I’ve driven off the road several times while falling asleep while driving. Thank G-d, noone was ever injured.)
My wife always complained about my snoring, and I have gotten disposable ear plugs (meant for shooting) for her, and those helped a little bit. About 11 years ago, I went in for a sleep study. An AHI number of between 5 and 30 is considered mild. My number of disturbances per hour was over 400. Basically, I was not truly sleeping. AND, I didn’t know it.
I got a CPAP machine, set at a pressure of 4, and now, I get up in the morning, can really concentrate, and rarely, if ever, need to nap during the day.
My wife now sleeps also, and everyone is happy.
posted by Izzy on 9-28-2008 at 12:37 pm
I, as well, have sleep apnea – except that my AHI is … 175. “severe” is 30. It’s fun when your doctor asks you how you’re still alive, really, quite hilarious.
While I do have the stereotypical body type, there are a few things that set my case apart – I don’t snore. At all. Those around me can’t tell I’m having an apnea. Moreover, I was so starved for sleep that I would actually have controlled fits of narcolepsy, particularly at friends’ houses. (try explaining that one…)
One thing for the recently diagnosed – your pressure needs can change over time – in my case, after about a month, my body decided to try to compensate, and I’ve had to have it adjusted 5 times thus far (I just got it to 15. This is largely due to the fact that I didn’t stay asleep long enough during the pressure assessment – We’ll see how it goes.) – so if you start feeling “bad” again (and you’ll know, trust me) go back to the specialist and LET THEM KNOW. Apparently it’s quite common.
posted by Lerren on 9-28-2008 at 5:05 pm
Hi everyone — I’m so encouraged by your comments! Thank you! I’m really looking forward to writing the next installment.
I’m on my third night of CPAP treatment. My pressure’s 11 and my AHI was 48 (which I thought was bad until I started reading these comments!). I’ve been experimenting with different masks, and it’s been somewhat rough at first — but each night I’ve slept longer stretches with the mask on.
Anyway, thank you for sharing, and keep it up! I’ll be back mid-week with more on my experience. And Amy, it sounds like you’ve got a lot of interested parties for the mouth apparatus!
posted by Chris Higgins on 9-28-2008 at 6:32 pm
Hi all! My dad is like many of the husbands/fathers/commenters above and has OSA. He snored throughout my childhood and the first 20ish yrs of my parents marriage. Mom (and me and bro) were all used to the noise, but he just wasnt sleeping well.
My Mom (a nurse) began working at a neurologist office w/ a sleep lab about 10 yrs ago, so as soon as she could convince him, he went in for a sleep study. The sleep lab rooms are great (I used to work there too) and so comfy it’s like being in a hotel. The wires and such can get annoying, but most patients sleep as good or better than they do at home.
He’s been on a C-PAP ever since, and the change in his was amazing. The first morning after he used it he talked about his dreams – he said he hadnt dreamed in decades before that (no REM sleep, obviously). He’s more alert, happier, etc and wont leave home w/out it – he even takes an adapter so he can plug it in on camping trips!
The funny side effect is that now my mom cant sleep with out the ‘white noise’ of the C-PAP. As soon as his insurance would pay for a replacement, he started taking the new one on business trips and mom kept the old one at home and turns it on even when he isnt there!
posted by Elphaba on 9-29-2008 at 9:35 am
Unfortunately, I lost a good friend of mine to sleep apnea last year :( He did not know he had it and died in his sleep. His dad found him.
Terrible, terrible tragedy. He was 29. his name was Stephen Pitts.
posted by mac_24_seven on 9-29-2008 at 11:49 am
Wow, what timing for this article! I’m set to go on a sleep test in two days and I’m looking forward to it. I’m hoping the results are as amazing for me as for many of the people I’ve read about.
I had never really thought about apnea until I was tentatively diagnosed. I went to the doctor for headaches and came out with a prescription for blood pressure and a sleep test. Pretty much the first thing the hypertension specialist said was apnea. The only thing I’m worried about is that I might not recognize the world from an alert point of view…
posted by Bob on 9-29-2008 at 12:14 pm
Here is the website (linked under my name) about the sleep apnea mouth guard for anyone who wanted more info. Good luck!
posted by Amy on 9-30-2008 at 5:39 pm
As soon as I get some health insurance, I’ll be pushing a primary care physician to prescribe a sleep study for me. It sounds rather unpleasant, especially in your first story, but it will be worth to finally know if I’m afflicted by this problem.
posted by Vashishta on 10-9-2008 at 11:52 am
Thank you Jaclyn. I too have major sweating and it can happen any time of day or night. I’ve woken at night with the sheets and pillow saturated. And, I live in a cool climate. I have severe sleep apnea, waking, on average, 36 times per hour. Mid-January I do an overnight sleep study using CPAP and hope that it works. I have been dealing with this for 19 years (I’m 64) and only in the last year have found a doctor willing to deal with the extreme fatigue which has rendered me pretty unfit for life.
posted by Sandra Ross on 12-17-2008 at 10:20 am