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ALENE PAYNE

Sleep awareness goes much deeper than trying to get in a few more minutes each morning before getting up and facing the day. Until about 30 years ago, the assumption was that a lack of sleep, while annoying, had no real consequences on a person’s health. Unless a person had narcolepsy or some other very rare disease affecting sleep, medical attention was not sought. Thankfully, in 2020, we know better. Sleep medicine is now a robust field, widely recognized for improving the health and well-being of millions of Americans.

There is nothing unusual about having the odd sleepless night, or even a few nights of insomnia. For the majority of people who experience this, minor changes such as keeping the bedroom cool and dark, and avoiding alcohol and heavy meals before bedtime, will have them sleeping peacefully in no time. Unfortunately, more than 42 million Americans suffer from on-going sleep disturbances ranging from sleep-disordered breathing to sleep apnea. These disturbances are much more significant than occasional insomnia; these disturbances can lead to death. The scariest thing about this is that many of the people affected have no idea that they are getting inferior sleep. Recent studies show that 1 in 5 Americans has mild Obstructive Sleep Apnea, 1 in 15 has moderate to severe OSA, and 1 in 50 is totally unaware and undiagnosed. That’s 4% of the adult population of the United States! The question then posed is, if they aren’t aware of it, how can it be so bad?

The human body is engineered to perform its own preventative maintenance daily. This process is called sleep. Cells regenerate, the brain processes the day’s information, the lungs, heart and kidneys all switch into low gear to prepare for the next day — that is, if the body is able to reach all of the various stages of sleep. Even though the respiratory rate decreases a bit during sleep, the breaths are deeper to insure that all body systems get plenty of oxygen-enriched blood. When something obstructs the airway, breathing stops. This is called Obstructive Sleep Apnea, and it signals the brain to wake the person up enough to breathe again. Every time the brain sends the “wake up” signal, the sleep cycles are disrupted and must start over; therefore, the brain doesn’t get to rest. The lungs cannot provide the necessary oxygen to the blood, so the heart has to beat more to compensate. In its turn, every system of the body is affected. More than 38,000 deaths each year are caused by cardiovascular issues directly related to sleep apnea. The person with untreated moderate-to-severe OSA has four times the chance of having a stroke and three times the chance of getting heart disease compared to the person without OSA or one who’s OSA is treated.

Why might you suspect that you have OSA or any other form of sleep disordered breathing? The most common symptoms include:

• Loud snoring and/or gasping episodes during sleep;
• Excessive daytime sleepiness;
• Falling asleep while driving;
• Memory impairment and loss of concentration;
• Morning headaches; and
• Restless legs during sleep.

Other factors that may put you at risk for sleep apnea include:

• High blood pressure (hypertension);
• Shift work, especially if you have to change shifts often;
• Obesity – BMI >30;
• Smoking;
• Excessive alcohol and/or sedative use;
• Pulmonary diseases such as COPD;
• Facial abnormalities, including deviated septum;
• Metabolic or endocrine diseases such as diabetes;
• Family history; and
• Large neck — >17 inches for men or >16 inches for women.

In adults, being male is a risk factor in itself. Children can also have sleep disordered breathing. The most common cause for this age group is large tonsils. More than 250,000 children each year have tonsillectomies to relieve this breathing obstruction, which is worse during sleep.

If any of this sounds familiar, the next step is to discuss your symptoms with your physician. Today’s medical provider has a checklist of clinical symptoms to help determine whether or not a referral for a sleep study is indicated. A sleep study involves spending a night in a medical sleep lab, hooked up by thin wires to various machines that measure things like blood pressure, respiratory rate and oxygen saturation, number of times awakened during sleep, leg movement, and most important, number of times breathing stops and length of time for each. When only mild sleep apnea is suspected, the sleep study may be done in your home with a smaller recording device that you put on and remove yourself. Sleep study results are interpreted by physicians with special board-certification in sleep medicine. These reports are then sent to the referring medical providers. If you are referred for a sleep study, your doctor will schedule a follow-up appointment with you to discuss your results and your treatment options.

The most familiar treatment option is the CPAP or BiPAP machine. This device, when used correctly, forces air through the obstruction and keeps the airway open with pressures specifically set for the patient. Today’s home units are small and very quiet. Supplemental oxygen and humidity can be added if necessary. Gone are the days of looking like a hockey goalie at bedtime. Masks that cover nose and mouth are available, but the most popular are the nasal masks that fit on the nose and nasal pillows. Nasal pillows fit in the nostrils; some are barely bigger than nasal cannula prongs. The payoff is night after night of restorative sleep — think of it as sleeping your way to better health.

Alene Payne, MS, RRT/RCP, is the manager of Cardiopulmonary Services at Vidant Beaufort Hospital where a fully-equipped sleep lab is among the department’s service offerings.