Frequently Asked Questions about Sleep Apnea

(The following was written 12/2000) I (Will) was diagnosed with Obstructive Sleep Apnea , a condition where one stops breathing, or pauses breathing, in their sleep. What I found is that it is a very common condition that doesn't get diagnosed as often as it should because people either don't realize they are doing it (if they don't have a sleep partner to tell them), or they don't think much of it and don't seek treatment. Some of the symptoms a person with sleep apnea feels is being in a constant state of exhaustion, and in my case needing an excessive amount of sleep to feel rested. The sleep deprivation often creates other problems as well, as people with sleep apnea often suffer from depression, bad short term memory, and medical problems such as heart disease and high blood pressure. While the stereotype of the sleep apnea sufferer is that of a middle aged overweight male, OSA affects people of all ages and body types, male and female.

They say an adult needs approximately 7-8 hours of sleep a night to feel rested. People with untreated sleep apnea often claim that they don't feel rested unless they get 12 hours or more of sleep. The reason for this is that the apnea keeps you from getting into a deep sleep. For example, here's what happened to me when I finally did seek treatment:

The first appointment with a sleep specialist was just an interview session. They try to determine from questions about lifestyle and such how likely it is that you would be a candidate for a sleep study. Overweight people are more susceptible to sleep apnea, mainly because there's more fatty tissue in the back of the throat to collapse and seal over the air passages while you sleep. Unfortunately, as I found out the hard way, it becomes a vicious catch-22. You can't lose weight because you have no energy to exercise, and because you have no energy and don't exercise you keep gaining weight. However, even skinny people can have OSA. I've had it as long as I can remember, even when I was in shape in high school playing varsity sports. I just didn't know it had a name or that I needed to do anything about it.

After the interview process, if you "qualify" you get setup for a sleep lab. In this, you spend the night in the lab and sleep with more than a dozen electrodes with wires running from them to a monitoring box attached to various parts of your body (legs, chest, face, head) . They remotely monitor you while you sleep, as well as video taping you. Kind of unnerving, but I managed to get to sleep anyway.

In the morning (they have you sleep approximately 6-8 hours), I filled out a survey that asks questions such as "what time do you think it is?" and "how many times did you wake up during the night?" The survey goes back to the doctor along with the results for a follow-up appointment.

At the followup appointment, I got the results. On the survey where I was asked how many times I woke up, I had answered twice. I had remembered waking up thinking I needed to go to the bathroom, but decided it wasn't worth trying to get around with all of the wires attached and went back to sleep instead. The real results? I had in fact woke up 117 times in 6.2 hours. No, that is not a typo ... One hundred and seventeen times! I was averaging waking up from stopping breathing 18-19 times an hour, or roughly once every 4-5 minutes. No wonder I never feel rested! What I found out much later from other OSA sufferers is that mine is not even considered severe (moderate). Many people had results much worse than mine.

The next step was to have another night at the sleep lab, where they fitted me with a mask and a CPAP (continuos positive airway pressure) machine. This machine essentially is an air compressor that blows room temperature air up your nose (and mouth if you're a mouth breather and get a full face mask) to keep your passages open while you sleep. Throughout the night they remotely adjust the air pressure to get the right level for the individual. After the results of that night, they place an order and in my case a week later I have my very own machine to take home and use when I sleep. Not the most romantic thing to have to wear to bed, but much better than being tired and grouchy all of the time!

The above have been my personal experiences. As I write this in December 2000, I actually get my CPAP machine this afternoon, so I can't comment on its effectiveness yet. Surgery is an option, but from everything I've read it is not very successful and in some cases is detrimental in stopping the snoring but not curing the apnea. Without the verbal cues of the snoring, it is difficult for a sleep partner to tell if you are still stopping breathing.

Sleep apnea has been linked to dying in your sleep (for obvious reasons) and greatly increases the likelihood of developing heart disease and high blood pressure. If you think you might have it or know someone who does, please get it checked out! SleepNet has some great resources on Sleep Apnea, including some discussion forums.

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Okay, here I am a week and a half later (12/15/2000). So, what do I think about the CPAP machine? Well, mixed feelings at this point. I've got a Sullivan ResMed CPAP S6 Lightweight. The Simplicity mask that I have on fits over the nose, and ordinarily I'm a mouth breather. What that means is I have to wear a chin strap thing kind of like you'd see people wear in old timey movies when they had tooth aches. The purpose of it is to keep your mouth from falling open while you sleep, since opening your mouth creates an air leak and prevents the air pressure being pumped into your nose from doing its job. I'm having a heck of a time keeping that chin strap from slipping off during the night, or if I get it tight enough that it holds my mouth shut I end up with a sore jaw and chin in the morning. Sometimes I end up just taking it off if I wake up around 3-4am for one reason or another.

It also doesn't help that I have sensitive skin, so when I wake up in the morning I've got red marks on the bridge of my nose from the mask that don't go away usually until mid-morning, and marks from the straps that go away within an hour or so.

That said, I feel like I am getting the benefit from it when I can keep my mouth shut. Most mornings I wake up feeling much more refreshed than I have in the past. I'm going to see about getting a bigger mask that covers both my mouth and nose so I don't have to worry about trying to keep my mouth closed while I sleep, and see how that goes. I'll update this after I see what happens with that approach.

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After a couple of weeks of using the full face mask (covers both my mouse and nose), I think I definitely like it a lot better. I'm finally feeling rested and feel pretty good when I wake up in the morning as far as having a good energy level goes. The only downside is that after eating all of that air all night, I wake up feeling slightly bloated and belching air for the first few minutes. Fortunately, the feeling goes away pretty quickly and I'm generally a lot more alert than before the CPAP machine. So where to from here?

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January 2007

I wrote the above after getting my diagnosis and CPAP machine, and felt it was worth keeping for history sake. At this point I have been on and off CPAP treatment for 6 years. To be honest, most of the time has been "off."  I struggled to adapt to the masks, and after the I struggled with the first ResMed Mirage full face mask leaking unless I tightened it down so tight it bruised my face, I bought a ResMed Ultra Mirage full face mask on my own, because it looked like an improved design that would address the shortcomings of the original. This was in 2004 after I had pretty much not used my CPAP machine for a couple of years. I tried to make that mask work, but struggled with it as well and eventually gave up on CPAP once again.

In the summer of 2006, I began noticing a significant problem with my memory. As is common with OSA sufferers, my short term memory was often spotty. However, I had always had a very good long term memory. At this time, I started losing parts of my long term memory. At first it was kind of a joke, but then it got scary. At one point while driving the same road I always took to work, I suddenly had no idea where I was. I didn't recognize where I was, and had to pull off. After maybe a minute it came flooding back and I resumed my drive, but it startled me. I had also been going through periods of depression that I had chalked up to being overcommitted/overworked and stressed out, but it was creating problems as well. While researching some of my symptoms online, I found references to sleep apnea, and the picture started becoming clearer -- I needed to resume my treatment whether I liked it or not.

In the course of my research, I found a site that has been a huge help for me - http://www.apneasupport.org.  On the discussion forums I found for the first time people to talk to that were going through the same thing, and it was not only encouraging, but I learned a lot that has helped me in my latest "on" period with CPAP treatment. One thing I had learned on my own is that masks that come down over the bridge of the nose just don't work for me. They tear up my nose, and lead me to stop using them. On the forums I found out about the Hybrid Mask, which is a full face mask that uses "nasal pillows" that insert into the nostrils rather than the nasal part resting across the bridge of the nose. I bought one in early November 2006, and other than when I was sick with the flu and then a sinus infection, I've been staying with CPAP this time. I feel like I've finally turned the corner on it.

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