By Maria Fleet
It’s a serious health problem many people don’t even know they have. They are completely unaware that they stop breathing many times in the night – and it can have a damaging effect on their health, especially for people trying to manage their weight.
It’s called sleep apnea, and the most common form of it – obstructive sleep apnea – affects one in 15 people, according to Dr. Jyoti Manekar, a family physician practicing in Atlanta, Georgia who also specializes in weight management.
Dr. Manekar describes sleep apnea as simply the pausing of breathing involuntarily for brief periods of time during sleep. Commonly, she says, people with sleep apnea “tend to snore, pause, snore, pause. And that pausing is called apnea.”
Dr. Manekar recently treated a patient named Todd who works as a school principal. When she examined him for his annual physical, she noticed that he had a very narrow airway, so she asked him how he slept. He said he slept ‘okay’ but admitted that he didn’t feel all that rested in the mornings and had always been ‘a light sleeper.’ “Then his wife jumps in and says, ‘By the way, he snores like a freight train. And I don’t even sleep with him in the bed anymore,’” Dr. Manekar remembers. When she probed further, Todd told her he would fall asleep at any time during the day, even at the wheel of his car at a red light! Dr. Manekar suspected Todd had sleep apnea.
Snoring is generally indicative of obstructive sleep apnea, which is characterized by a mechanical obstruction of the breath, usually caused by tissue in the neck which, when relaxed, can block the airway. A second kind of sleep apnea is called central sleep apnea, which is caused by a failure of the brain to adequately signal the lungs to breathe. A third type of sleep apnea is mixed sleep apnea, which is a combination of the first two.
In each case, the paused breathing is depriving the person of oxygen, which can have a host of follow-on effects. “A lot of people think snoring is just a cosmetic issue, driving their partners out of the bedroom. But it’s just not that,” says Dr. Manekar. “It actually lowers or decreases your life expectancy and increases diseases like heart disease, high blood pressure, diabetes, obesity and liver disease…There are so many different side effects that happen from having sleep apnea.”
Sleep apnea and excess weight are linked. “As you gain weight, your risk does increase,” Dr. Manekar explains. For a person weighing 150 pounds, she says, gaining just 10% of their body weight – 15 pounds – increases their chance of getting sleep apnea six-fold.
If a person is experiencing fatigue during the day, or having unexplained headaches, it could be caused by undiagnosed sleep apnea. If you suspect you have sleep apnea, Dr. Manekar advises you to talk to your primary care doctor, who may refer you to a sleep specialist who will likely order a sleep study, which can be done in a lab overnight, or even at home using some simple equipment.
Dr. Manekar’s patient Todd did a sleep study, and discovered his breathing paused 70 times during the night, and his oxygen dropped as low as 88. “That certainly can make anybody tired,” she says.
Dr. Manekar explains the daytime fatigue caused by sleep apnea can seriously damage a person’s quality of life. As with Todd, it can cause difficulty focusing. Lack of sleep can impair decision-making and cause irritability. It can also have a detrimental impact on weight management, eroding the resolve needed to stay with an exercise regimen and meal plan. Untreated sleep apnea can set up a vicious cycle for people carrying excess weight. “You have sleep apnea…you’re more tired. And then when you’re more tired, obviously you are not going to do as much. So, your metabolism goes down. When your metabolism goes down, you’re going to gain weight… and then when you gain weight, your sleep apnea further gets worse,” Dr. Manekar explains.
Fortunately, there are a number of effective treatments for sleep apnea, and some are as simple as changing one’s sleeping position. “Sleep apnea happens mostly when you sleep on your back when the muscles are kind of squeezed. So, if you try to sleep on your side, it might reduce the pinching of the airway,” Dr. Manekar recommends. She adds that raising the head of the bed a small amount might also improve obstructed breathing. She cautions that drinking alcohol at night or using sedatives can cause or worsen the condition. Those substances relax the neck muscles, causing more restriction in the airway, she explains.
For people who have a mechanical obstruction caused by their tonsils or adenoids, Dr. Manekar says they might consider consulting with an ear, nose and throat doctor to see if surgical removal of tissue would open their airway to allow better breathing at night. In some cases, a simple dental appliance worn during sleep is enough to hold the mouth in a way that keeps the air passages open.
One of the most common remedies for sleep apnea is a CPAP machine. CPAP stands for “continuous positive air pressure” and that is exactly what the machine does. The user wears a fitted mask over their nose and mouth connected to a tube on the machine, which applies a continuous moderate amount of air pressure into the airway so it stays open. It’s an appliance that takes some getting used to, but it has proven to be very effective. “A lot of times I hear patients saying, ‘I don’t like to wear a CPAP machine. It feels very claustrophobic,’” Dr. Manekar says. She suggests that her patients try to acclimate to it by sitting and breathing with it during the day for 30 minutes or so. “It might take about a month for most people to kind of get used to it. And then they can sleep with it throughout the night,” she says.
And sleeping through the night has made a profound difference to Dr. Manekar’s patients. “They tell me that they have never slept like this before in years, and that’s really rewarding to know that they’re finally getting a good night’s sleep and they’re not waking up tired,” she says. Her patient Todd was one of those success stories. He began using a CPAP machine and came back to her for a follow-up appointment three months later. “He was like a new person, all energetic. He had lost 10 pounds. He said, ‘I’ve never slept like this in my life before, so I got my sleep back.’ And his wife said she was back in the bedroom with him.”
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