The good news is that sleep apnea can be treated, writes Dr. Rébecca Robillard.Андрей Клеменков/Getty Images
The Sleep Whisperer is a series of columns offering insights and advice about sleep health. It is not a substitute for seeking professional medical care.
As a sleep scientist, I’ve spent years studying sleep apnea, the second most common sleep disorder after insomnia. This condition, which causes people to stop breathing during sleep, has multiple implications for overall health. Yet, due to its insidious nature, many people remain unaware that they have it.
Notably, sleep apnea can camouflage as other conditions, including depression, low libido, attention deficit hyperactivity disorder (ADHD) and even age-related cognitive decline. And although age and obesity are risk factors, sleep apnea can occur at any age, including childhood, and affect all body types.
The good news is that sleep apnea can be treated. Of course, to treat it, one must first know they have it. Here are some key points to know.
1. Whether you realize it or not, you probably have some level of sleep apnea
During sleep, most of us have periods when our breathing becomes shallow or stops altogether for at least 10 seconds. This is normal. But when this happens more frequently, at least five times per hour, the minimal criteria for sleep apnea is met. In more severe cases, respiratory arrests can occur 30, 120 or even more times every hour. Most often, apneas are caused by a mechanical blockage in the mouth and throat. These are what we call obstructive sleep apneas. During sleep, the mouth and throat muscles lose some of their tone and are more prone to collapse, making it more difficult for air to pass through. This is worse when sleeping on one’s back, as gravity pulls the throat’s fat and muscle tissues down, which further narrows the airway. Other times, it is the brain that stops signalling to the lungs to contract and expand in order to breathe. These are called central apneas.
Both kinds of apnea cause repeated mini-awakenings as the body tries to resume breathing, thereby preventing a restful night’s sleep.
2. Sleep apnea worsens health, accelerates biological aging and shortens life
Apneas don’t just make you feel sleepier. They also stress the heart and brain as blood oxygen levels drop. This affects thinking skills, notably lowering school or work performance, degrades mental health, and increases risks of accidents. Repeated lack of oxygen also drives oxidation and inflammation across the body and worsens the risk and severity of several health issues, including eye problems, diabetes, hypertension and cardiovascular disease.
A group of sleep researchers including myself recently found signs of accelerated biological aging in people with severe sleep apnea. And previous research led by Dr. Tetyana Kendzerska from the University of Ottawa found that sleep apnea predicted subsequent diabetes, cancer, cardiovascular problems and earlier death. In other words, not only does sleep apnea age our body prematurely, if left untreated, it can also shorten our lifespan.
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3. There are sometimes warning signs, but ultimately a sleep test is needed
It is estimated that 80 to 90 per cent of people with sleep apnea are undiagnosed. Symptoms can be easy to miss or chalked up to other causes. Nevertheless, possible warning signs include morning headaches, excessive sleepiness during the day, low mood, irritability, poor concentration and memory, reduced libido, erectile dysfunction, or loud snoring. Women with sleep apnea may have exhaustion rather than overt sleepiness, and less snoring.
Other times, people may not notice any symptoms at all. In fact, research volunteers who come sleep in my lab, generously donating their time to science – including those who thought of themselves as good sleepers – often leave with an unsuspected diagnosis of sleep apnea.
Ultimately, the only way to find out if you have sleep apnea is to do a sleep test.
4. Sleep apnea is readily treatable
Thankfully, many people with sleep apnea find that effective treatment can be a game changer. Some use a mask connected to a pump that gently pushes air through the nose and/or mouth. There are several different kinds of these positive airway pressure, or PAP, machines: continuous PAP (CPAP), auto-adjusting PAP (APAP) or bi-level PAP (BiPAP). Others use a special mouthpiece to bring the jaw slightly forward and keep the back of the throat open (i.e. a mandibular advancement device). Sometimes, simply strapping something to one’s back to reduce the likelihood of sleeping supine can reduce the number of apneas (i.e. positional therapy).
For others, losing weight can completely cure sleep apnea. However, sleep-related breathing disruptions can make weight loss even more challenging because it affects how food is metabolized and can lower energy and motivation. Leveraging other sleep apnea treatments concurrently and getting additional supports for dieting and training programs can make the journey easier.
Unfortunately, women tend to have more subtle forms of respiratory disturbances and be undertreated. Research increasingly shows that what may look like less severe sleep apnea in women often has serious health consequences, notably for heart health.
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5. Start by speaking to your doctor
If you suspect you may have sleep apnea, speak with your family doctor and ask for a referral to a sleep clinic. Typically, you would then meet with a sleep physician and undergo an overnight sleep test in a sleep laboratory. (This won’t be as bad as you might think – you will have your own private room and you can wear your regular pyjamas!)
Some clinics may offer the option of getting tested at home with portable equipment. Before going with this option, check whether this could affect your health insurance coverage.
Unfortunately, there are major discrepancies in public health insurance coverage across Canadian provinces and territories. In Ontario and Manitoba, for example, public health insurance reimburses part of the treatment. Saskatchewan gives loans for PAP machines. In most other provinces, there is no universal public coverage accessible to everyone. Since sleep apnea is a medical condition that has repeatedly been linked to major health problems that could often be prevented or reduced with treatment, this creates health disparities that have yet to be addressed.
Dr. Rébecca Robillard, PhD, is a clinical neuropsychologist and associate professor at the School of Psychology at the University of Ottawa. She also leads clinical sleep research at the Royal mental health hospital. She co-chairs the Canadian Sleep Research Consortium, a national hub of sleep scientists and clinicians.