Katharine Lawes knew what sleep apnoea was before she ever spent the night in a sleep lab. Her older brother, a cousin and a friend had all been diagnosed with the condition. So when she went on holiday with her family two summers ago, she understood what it meant when her son told her that she’d been gasping for air during the night.

Lawes, 67, also heard how serious sleep apnoea could be. “You’re tired during the day because you haven’t slept. Your body’s been working too hard to stay alive,” Lawes, a Canadian who lives in Spain, recalled her brother saying. “When you wake up, you’re exhausted.”

That’s exactly what happens during sleep apnoea, says Dr F Javier Puertas, head of the Sleep Medicine Centre at La Ribera University Hospital in Alzira, Valencia. In people with sleep apnoea, the upper airway narrows, collapses and cuts off, or obstructs, the body’s air supply during sleep. Not surprisingly, the lack of air causes many people to first snore, then gasp and wake up in order to restore normal breathing.

“In some cases it happens hundreds of times during the night,” Puertas says. “The patient isn’t aware of these awakenings. Normally they last around three or five seconds, and at the end of the night patients only remember that the sleep hasn’t been refreshing.” 

Not all snoring is sleep apnoea. But very loud snoring, because of the obstructed airway, is sometimes a sign of it. Other symptoms: daytime sleepiness, morning headaches, high blood pressure and abrupt awakenings or periods when someone else notices that you’ve stopped breathing.

 

Untreated sleep apnoea

...has been linked to problems with glucose control that can lead to diabetes, and with cardiovascular problems, such as an increased risk of high blood pressure. And there’s another potentially  deadly effect: traffic accidents caused by sleepy drivers. It’s not clear exactly how many such crashes there are, but sleep experts in Europe estimate around 20 per cent.

This figure is supported by a survey last year by the European Sleep Research Society, which found that one in five Europeans said they had fallen asleep at the wheel in the previous two years. Among those who had snoozed, seven per cent said they had had a motor vehicle accident as a result.

The concern about accidents has led a working group for the European Commission on Sleep Apnoea and Driving to recommend that the EU require drivers with sleep apnoea to get it under control, or else risk losing their licenses. The good news? “It’s been demonstrated clearly now that effective treatment of sleep apnoea removes any excess risk of an auto accident,” says the chairman of the working group Dr Walter McNicholas, director of the Pulmonary and Sleep Disorders Unit at St Vincent’s University Hospital in Dublin.

 

You may not have known about this condition 10 or 20 years ago

Two decades ago, as few as four per cent of men and two per cent of women had sleep apnoea, but those numbers are increasing, in part because more people have risk factors for it, such as obesity, McNicholas says. Genetic factors may also play a role. “Figures in the region of five to ten per cent are now regularly talked about as prevalence figures for significant sleep apnoea,” he says. That translates to between 35 and 70 million Europeans.

With more cases comes another concern. “When you consider that you diagnose such people by the monitoring of their breathing while they sleep, then the logistics of that are immense,” notes McNicholas. As a result, a good deal of research is focused on ways to easily and effectively find sleep apnoea, both in sleep labs and in the home. Devices that can detect sleep patterns, or portable monitors that can track sleep while worn to bed at home, are two promising solutions.

Today, most people still must spend a night in a sleep lab in order to be diagnosed. Many find it’s not as strange an environment as they expected. “I thought I was going to have a hard time, but I fell right asleep,” Lawes says. She says it helped to keep in mind that finding an answer to her sleep problem was going to be a good thing. 

Treatment can be another story. Probably the most familiar—and at the same time most common and most effective—treatment today is CPAP, which stands for continuous positive airway pressure. The system involves a small air pump, tube and a mask that covers the nose (or nose and mouth) during sleep to direct air gently into the upper airway.

 

The thought of sleeping with a mask for the rest of one’s life

...is certainly off-putting to some, Puertas says. “I tell my patients that the CPAP is like glasses.” When you wake up, you put your glasses on. In much the same way, he says, when it’s time to fall asleep, you put on your CPAP.” After a while, some people even develop an attachment to their device. Says McNicholas, “They actually go to bed and snuggle up with the CPAP mask.” He believes it’s the body’s subconscious reaction to being able finally to relax and have a restful night’s sleep after months or years of untreated sleep apnoea.

Still, a CPAP takes some getting used to. When Lawes first began treatment, the mask didn’t fit correctly. A smaller mask was the solution. And later, when she felt the air itself was a little bothersome, she was able to get a humidifier attachment to moisten the air and help her breathe easier.

Sometimes she falls asleep without the mask or takes it off halfway through the night—a not-uncommon situation, Puertas says, but after a few days without CPAP, the full symptoms of sleep apnoea will return. Lawes notices a difference the day after she doesn’t use the CPAP for the full five hours or so recommended; she’s more prone to falling asleep during the afternoon and doesn’t feel as alert and in good health on those days. Knowing that consistent treatment is essential for her health makes it easier to try and be consistent, she says. 

Partners, even those who are leery at first, are many times also comforted by the fact that the CPAP does an important job: instead of worrying that their partner will stop breathing, there is relief, Puertas says. Some partners do complain about the machine’s noise, and that’s not an easy issue to solve, he says. But the bedroom often gets quieter because there’s less snoring. “Most of them prefer the uniform—and normally low—CPAP noise to the loud snoring,” Puertas says. And having a supportive partner has been shown to help people stick with CPAP, according to a new study.

Lawes has gone on holiday with friends and family since beginning treatment. On one trip, after she took off her mask during the night, a friend woke her up to tell her to put it back on because she was snoring.

Lawes is also spreading the word about sleep apnoea. A friend with some health issues, including heart trouble, was told she might have sleep apnoea but was afraid to go to the sleep lab. “She was petrified to take the test,” Lawes says. “When I told her the seriousness of it, she went and got tested.” After a month using her new CPAP she told Lawes that she was getting a lot more sleep, and that she was looking forward to the results of some new tests about her heart.

More and more, awareness of sleep apnoea brings people to their doctor’s offices. “They’ve read about the risk of heart attack and stroke, and they’re aware that untreated sleep apnoea puts them at higher risk of those medical complications,” McNicholas says. “And they actually come expressing a concern about that and a desire to be investigated for sleep apnoea.”

Many people are surprised that they do get used to a CPAP. “People say in advance of treatment, ‘I couldn’t sleep with that thing.’ I regularly get that comment in my practice. But the reality is, they tolerate it very well,” he says, “and they get a huge benefit.”

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