“When sleep apnea treatment is successful, it can change your life,” says Ronald Chervin, director of the Sleep Disorders Center at the University of Michigan.
“People report that they feel more refreshed in the morning, they think and work better, and they treat other people around them better,” says Chervin. “And if that’s not enough, we tell them they’ll look younger and more attractive.”
In a study that used sophisticated three-dimensional cameras, Chervin and his colleagues at the University of Michigan took pictures of the faces of 20 adult overweight apnea patients before and after they had slept with CPAP machines for at least two months.
CPAP (continuous positive airway pressure) machines are the gold standard treatment for apnea. You wear a mask over your nose while you sleep, and the machine supplies pressurized air to keep your throat open. Those who use it regularly have the greatest likelihood of eliminating their sleep apnea,” says Chervin.
In Chervin’s study, “a panel of 22 raters, who didn’t know which photos were taken before and which were taken after the 20 subjects started treatment, were twice as likely to judge that the subjects looked more alert, youthful, or attractive in the after photos than in the before photos,” he says.
But a better appearance is icing on the cake. Avoiding the health problems associated with apnea is more significant. “Sleep apnea can be a deadly disease,” notes Chervin.
On the night Supreme Court Justice Antonin Scalia died last February, his CPAP machine was on the nightstand next to his bed. It wasn’t plugged in. Scalia was one of an estimated 25 million Americans with obstructive sleep apnea. Most don’t know they have it.
People with sleep apnea stop breathing for 10 seconds or more at a time, as many as 300 or 400 times a night. Each bout usually ends with a snort, as breathing begins again.
What causes it? In obstructive apnea, the most common kind, the muscles at the back of the throat relax and block the airway.
The cause of Scalia’s death was never determined—the family didn’t want an autopsy—but there was speculation in the media that sleep apnea may have played a role.
What happens night after night
It’s not that you can die from lack of oxygen on the spot. Restricted breathing pushes the body into a “flight-or-fight” response, part of which involves diverting (oxygen-rich) blood to the brain. That means blood vessels constrict and the heart rate increases. With the oxygen supply already reduced, that can damage the circulatory system, especially if it happens night after night.
“Many years of untreated sleep apnea likely kills many people through cardiovascular events like strokes, heart attacks, or arrhythmias,” explains Chervin. “When the person dies, it’s not usually recorded that the sleep disorder had a role in pushing them toward that outcome.”
Scalia had some of the classic characteristics of apnea patients: he was an older male, overweight with a thick neck, and a smoker.
“Obesity plays a big role in the development of apnea,” Chervin says. Extra weight can mean more fat deposits in the soft tissue that surrounds the throat, which can obstruct breathing.
Among 690 randomly selected middle-aged Wisconsin residents, those whose weight increased by 10 percent or more over a four-year period were six times as likely to develop moderate-to-severe sleep apnea as those who didn’t gain weight.
While putting on pounds can make apnea worse, shedding them can make it better. Among 49 obese Swedish men who cut their calories enough to lose an average of 27 pounds over a year’s time, apnea episodes fell from an average of 36 an hour to 19.
Hits men harder
Researchers estimate that men are twice as likely as women to have sleep apnea. “We’re not sure why,” says Chervin. “One suspicion is that women are protected by the hormones estrogen and progesterone, which stimulate respiration and may help prevent muscles of the upper airway from collapsing.”
Tellingly, when those hormones decline with menopause, “women’s susceptibility to apnea seems to catch up to a good degree to men’s,” Chervin explains.
How can you tell if you have sleep apnea and should see a doctor?
Loud snoring is one clue. Often the first alarm is raised by a spouse who is fed up with being kept awake night after night (although snoring isn’t necessarily a sign of sleep apnea).
Sleepiness during the day is another warning sign.
“People with sleep apnea can be sleepy all the time,” says Chervin. “They fall asleep during a one-on-one conversation with their boss, or while they’re driving, or sometimes even in very unlikely situations such as during sex.”
Diagnosis and treatment
If a doctor suspects that you have sleep apnea, you’ll probably spend a night at a sleep clinic, where you’ll be attached to electrodes and sensors that record your sleep as well as the frequency of any apnea episodes.
If you’re diagnosed with apnea but can’t tolerate a CPAP machine, there’s surgery or oral devices that fit between your teeth and help maintain an open upper airway. “But for some people, those devices will not completely eliminate their apnea,” notes Chervin.
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