TRYING TO GET A RESTFUL NIGHT’S SLEEP Brad Axelrod, PhD Director, American Alliance for Healthy Sleep
I grew up with allergies and hay fever, leaving me congested and sniffling much of the time. So, when being congested turned into snoring, I was not so surprised. My wife would have to wake me from time to time, asking that I try to stop the snoring when sleeping. Lying face down on the bed, or even just rolling on my side worked for a while. And by “a while” I mean for a few years. But, then the awakening became a bit more frequent. My wife’s morning reports became more insistent, and our mutual frustration increased a little. Sleeping face down was not diminishing my snoring anymore. So, then I tried decongestants and antihistamines before bed, and these over-the-counter aids were intermittently helpful but not in a consistent manner. In the end, I brought the issue to my family physician who recommended a trip to a sleep specialist to formally evaluate my snoring. SLEEP CLINIC As far as sleep problems are concerned, I never thought that I had sleep apnea to the point that I was not obtaining sufficient sleep. I certainly didn't ever recall having episodes of gasping myself awake because I couldn't breathe while sleeping, and my wife also did not seem to think that I ever stopped breathing or was gasping for air. As for feeling sleepy during the day, there were times that I would take a 10 minute “power nap” at lunch or feel drowsy while driving home at the end of the day. But, I viewed those incidents as being consistent with a typical hard-working lifestyle, not something that needed medical treatment. Regardless, on the recommendation of my family physician, I went for an evaluation to find out if I did indeed have sleep apnea. My initial evaluation at the Sleep Clinic helped me begin to understand the complexity of sleep medicine and the need to have someone who is aware of all of the moving parts involved in getting good sleep. I answered questions about the quality of my rest, sleep schedule, bedtime activities (Do I watch TV in bed? Do I read in bed before turning off the lights?), and daytime behaviors (What time is my last caffeine drink before bed? Do I exercise before bed?). After what seemed to be a typical physical examination, the physician took out a light and asked that I open my mouth so he could evaluate the structure of my mouth, size of the opening of my throat, and any possible obstructions, including tonsils. After the initial appointment, the doctor stated that it would be in my best interests to undergo a formal sleep study. He told me that such a study would help figure out if I have “normal snoring” or sleep apnea, and I thought, if I had no gasping, then I probably had snoring that should be able to be treated. INTRODUCTION TO CPAP TREATMENT After undergoing the full overnight formal sleep study, I had my follow-up appointment with the sleep physician. Despite my belief that I was only experiencing occasional snoring, the sleep study showed that this was not the case. The results indicated that I was clearly having apnea events (stopping breathing briefly) on the average of once every two minutes. He told me that my apnea was significant and required treatment. People who don’t get treated for apnea are at higher risk for a myriad of other health problems, including strokes, heart attacks, diabetes and other medical conditions; it is imperative that sleep apnea be treated appropriately. The clinician discussed several possible treatments, some of which were more invasive and permanent than others. A friend of mine had attempted surgical intervention but found that after the surgery, recovery from the surgery, and some complications, his snoring remained the same. In the end, he needed a CPAP machine anyway. These types of devices, positive air pressure machines, are the most common intervention to treat sleep apnea. Both Continuous Positive (CPAP) or Bi-level Positive (BiPAP) air pressure devices send air through a facial (or nasal) mask to alter the pressure in your airway and effectively diminish the apnea events. Because the use of a CPAP machine could be discontinued or adjusted if it did not work, I was more in favor of trying out the CPAP device rather than undergoing any kind of surgical intervention and decided to begin treatment with a CPAP machine. The first few weeks with the CPAP did require some adjustment. I had to get used to sleeping with the mask on. I typically didn't have any difficulties putting on the mask and getting comfortable, but sometimes the sound of the air leaking from the mask would wake me up, and I would not have patience to get it on straight, or I would awaken in the middle of the night to use the bathroom and choose not to put it back on (until my wife told me to do so). Sometimes I would even try to keep it on, but wake up in the morning with the mask on the floor ,and the CPAP turned off. Although it took some getting used to, with time and perseverance, I got used to the CPAP and continued to use it diligently. BENEFITS OF TREATMENT The first clear benefit was that my snoring went away. My wife said that the sound of the CPAP fan was minimal in comparison to the sound of the snoring. The next benefit was that because I was no longer taking a decongestant (for my allergies) and with the use of a humidifier in the CPAP, my sinuses no longer felt dried out upon awakening. I stopped experiencing bloody noses and generally felt that daytime breathing was easier than it had been. The third benefit of CPAP treatment was a benefit that crept up on me slowly. After a few months of using the device, I noticed that I was no longer craving my nap after lunch. I was also alert on my commute home from work, without any of the drowsiness I had previously experienced. Most importantly, I returned for a follow-up sleep study after using my CPAP for several months. The results of that study showed that with the CPAP treatment, my apnea events had dropped significantly, to once every 20 minutes. LIVING WITH A CPAP Having a CPAP at the side of the bed was not that difficult to get used to. Once I had a place for the device, it became an easy part of my bedtime routine. In the mornings, I would empty out the humidifier water. Once weekly I would spend about 15 minutes cleaning the device, tubing, and mask. It sure does not seem like such a difficult thing to incorporate to avoid serious medical problems or drowsiness during the day. Traveling has been a bit of a learning process. When flying, the CPAP has to be carried on so it can be inspected and to prevent it from being damaged. But, knowing that I will sleep well, and be rested each morning, reminds me that is slight inconvenience is an excellent price for good health. The lesson here is that, although you may not be aware or feel like you have a sleep disorder, if you are exhibiting symptoms of sleep apnea, or any other sleep disorder, it is best to talk to your physician. While testing and beginning CPAP, or any other treatment, may seem burdensome in the beginning, the benefits to your long-term health and well-being are well worth it.