Sleep Apnea: One More Thing To Deal With

Pat Salber

First published 3/28/11 on The Doctor Weighs In

I work hard at staying healthy – you know, eat right per the Michael Pollan prescription, exercise (5 days a week with a trainer and two on my own), all things in moderation – except for the Chardonnay – my beloved, but almost only vice.

But I got the bad genes to contend with (thanks Mom, thanks Dad).  I long ago reconciled myself to taking a pile of pills every morning to control the array of metabolic syndrome issues I inherited.  There are two pills for blood pressure (and, most recently, a smelly, neon yellow pill to raise my potassium level – lowered by the diuretic I take).  Then there is the statin for bad lipids and the allopurinol to prevent recurrent gout attacks.  And three pills, to replace stuff I don’t make enough of any more – thyroid, a selective estrogen receptor modulator (SERM), and Vitamin D.

Despite all of this (or rather because of all of this), my “numbers” are all normal or almost normal.  My BP is good as are my lipids.  My glucose is slightly elevated, but my Hemoglobin A1c is normal.  My last bone scan showed a slight improvement and my thyroid levels are consistently where they should be.  Whew.  It’s lots of work, but it’s working.

So, imagine, my disappointment when I got a letter from Kaiser, my health care system, a few days before my birthday, telling me that I had severe sleep apnea.  Not mild or moderate – but severe.  Bummer.  Of course, it wasn’t a complete surprise as my husband had been telling me for several years that he had observed scary apneic spells and, of course, I snore (and so does he!).  For the last year or so, I also had a lot less energy than I used to, but I had slowly compensated by going to bed earlier and earlier, “sleeping” long hours hoping to get in at least 8 good ones.

About a month ago, my husband and I met together with our shared internist.  We told on each other. “He snores.”  “She stops breathing.”  “She goes to bed at 8.”  “He wakes me up.”  And so on, and so on.  She asked each of us some questions and then scheduled our sleep studies.  I got the one designed for high risk people.  He went to a group class.

The sleep studies are now done at home, but they are, nevertheless, a bit unpleasant.  I had to put two elastic straps around my chest and belly, respectively.  They were hooked up to a machine that measured my breaths.  I also had plastic nasal prongs in my nose and a pulse oximeter on my finger.  It gave me a hint of how much sleep must be disrupted in hospitalized patients attached to no end of tubes, and prongs, and instruments.  No fun, no fun, no fun.

The sleep study results showed that I have an Apnea Hypopnea index (aka Respiratory disturbance index or RDI) of 41.2 – normal is less than 5.  Apneas are pauses in breathing, often due to an obstruction of the airway.   Hypopneas are shallow breaths that do not support ventilation.  There are also abnormal respiratory events associated with arousal from sleep that do not technically meet the definitions of apnea or hypopnea, but do disrupt sleep.  These are known as Respiratory Effort Related Arousals (RERA).  All three are counted in the calculation of the RDI).

Ok, now, I have another thing to contend with…but this time the treatment is not as simple as taking a pill.  The treatment is continuous positive airway pressure, or CPAP.  Although the Kaiser letter described it as “a small bedside machine and mask that you wear during sleep to prevent the collapse of the airway and to maintain normal breathing during sleep,” it is actually a quite ugly mask hooked via a plastic tube to a machine that sits on your bedside table. I am looking forward to this treatment about as much as having fillings filled without anesthesia or going to sleep on a bed of nails.

As I mentioned, the mask goes over your nose and is attached to the “small bedside machine” with a large plastic tube.  Yuk. [Hey, the model in the photo over there doesn’t look too bad, but who actually looks like that when they go to sleep – note the combed hair, eye shadow, fresh lipstick and a grin???]

You often awake with the mask imprinted on your face.  You have to take it off and put it back on to go to the bathroom in the middle of the night.  And you have to take it with you when you travel (I am assured that you can take it onboard and it doesn’t count as carry-on.) This treatment just does not fit into the body image I have for myself.  OK, things could be worse – and one day, I am sure they will be.  But for now, this is one more thing to deal with.

I go to get the thing tomorrow.  So, I guess I will be using it for the first time tomorrow night.  I’ll let you know how it goes.  I am hoping for the best, but expecting the worse.  A brief perusal of Sleep Apnea social networking sites (yes, there are such things) revealed an occasional miraculous improvement in symptoms – “no longer tired.” “feel like a new person.”  But many described months of trial and error before they got the right machine, the right mask, the right humidity, the right attitude? And these are the people who stick with it.  I know from my health plan experience that many sleep apnea patients find the treatment worse than the disease.  I am sure there are millions of dollars worth of CPAP machines in the collective basements of the millions of people with sleep apnea.

So what are the alternatives?  I could lose more weight.  My BMI is normal, but I “carry my weight” around my middle (an apple, my dear readers) and my neck circumference just reaches the level associated with sleep apnea.  OK, I guess I will give it a try.  I could give up Chardonnay – or at least move the timing to earlier in the day so it is all metabolized long before bedtime.  OK, I guess I will give that a try too.  I could get surgery – usually a uvulopalatopharyngoplasty (UPPP) – but overall there is only about a 40% success rate.  I will probably explore that too – and share what I learn with you.

Wish me luck … and, let me hear from you if you have a good (or bad) sleep apnea story.  Misery loves company, you know.

Pat Salber MD MBA is Principal of Zolo Health Solutions and writes at The Doctor Weighs In.