Mending broken sleep Sleep apnea, the dangerous cessation of breathing during sleep, is being diagnosed more and more. A simple machine can bring refreshing relief.

Posted: February 06, 2006

For more than two years, my snoring kept Laura awake most nights. It often got so loud that she used earplugs and buried her head under a pillow to escape the din.

Nothing worked, and we were both exhausted. I felt guilty for ruining her sleep, and I blamed her for disturbing mine when she roused me several times a night to shut me up.

Now I no longer snore and we both sleep better.

Each night for the last seven weeks, I have worn a breathing mask so air can be pumped through my nose and control my sleep apnea. I'm likely to wear it every night for the rest of my life.

To the uninitiated, it looks scary - like Darth Vader on life support - but to my wife it's the new sexy.

I am just one of a growing number of people diagnosed with obstructive sleep apnea, a serious condition that saps work productivity, diminishes the pleasures of life, and can lead to heart disease and death.

An Inquirer computer analysis found that the number of hospital patients diagnosed with sleep apnea nearly doubled in the area and across the nation between 1999 and 2003. Sleep doctors here say they are seeing a similar rise in office visits for the problem.

Doctors explain the surge by citing the nation's obesity epidemic - excess weight is a major risk factor for sleep apnea - and a growing awareness of the problem among doctors and the public.

The condition once was believed to affect mostly older, overweight men, but now doctors are often finding it among women, children, and slimmer people like me. "It runs the entire gamut," said Frank Trudo, a sleep doctor with Virtua Health in South Jersey.

More than 12 million people are thought to be afflicted, though most are undiagnosed.

Sleep apnea occurs when a person's breathing is inhibited or stops altogether. Those who experience more than five interruptions an hour are considered to have the condition. In severe cases, people have 80 or more interruptions an hour.

Muscles relax during sleep. That can cause the closure or constriction of the airway. Overweight people have more tissue to block the airway, putting them at higher risk for sleep apnea.

For many, sleep apnea leaves them too tired to watch a movie with their kids or go out to dinner with friends.

The frequent fatigue can have serious consequences: It increases the risk of car crashes and other accidents.

"Studies have shown sleep deprivation can impair driving to the same extent as alcohol," said Virtua's Trudo.

Also, sleep apnea has been shown to aggravate high blood pressure, heart disease, and blood sugar problems. A study recently in the New England Journal of Medicine reported that sleep apnea "significantly increases" the risk of stroke.

"What we do by treating you is immediately make you less sleepy during the daytime and improve your quality of life," said Allan I. Pack, director of the Sleep Center at the University of Pennsylvania Medical Center. "We also believe that we will improve your long-term health and reduce your risk of cardiovascular disease and other illnesses."

The most effective treatment - contrary to my nightmares of a surgeon's scalpel - is a simple mechanical device, called a CPAP machine, that pumps humidified air into my nose and keeps my airway open through the night.

Almost everyone with sleep apnea can be effectively treated with CPAP, which stands for continuous positive airway pressure, or similar devices.

Doctors say weight loss and lifestyle changes, such as giving up that last glass of wine near bedtime, can be effective. In mild cases of sleep apnea, a dental appliance worn at night to push the jaw forward and prevent airway blockages can also work.

Most sleep doctors view surgery, which removes tissue that blocks the airway when muscles relax, as a last resort.

But first you must be diagnosed. Up to 90 percent of cases are undiagnosed, experts estimate.

I was one of them until my new primary-care doctor saw me as a likely candidate.

The diagnosis process entails spending a night or two at a sleep center with wires attached to your head and body so your physical and mental activity can be recorded.

That's what Paul Welch did at Virtua Health's SleepCare Center in Cherry Hill. I spent two nights at the sleep lab at Pennsylvania Hospital in Philadelphia in November.

I wasn't thrilled to sleep in an unfamiliar bed with wires sprouting from my head like Medusa's snakes. Despite my trepidation, I was able to sleep both nights.

The first night, I slept 90 percent of the time. I snored the entire night. And I had respiratory interruptions 6 1/2 times an hour, a figure that jumped to 33 times an hour during the more important REM (rapid eye movement) sleep.

The following night, in addition to the wires, I had a CPAP mask strapped over my nose.

That night I slept 93 percent of the time, did not snore, and experienced fewer then two interruptions an hour, well within normal.

"Your sleep quality was much better," said my pulmonologist, Eugene M. Lugano. He added that with the CPAP device I achieved a "much deeper-level sleep and much more REM sleep."

The next morning I felt refreshed despite the strange sleeping conditions.

Vince Silenzio of Maple Shade was diagnosed with a severe case of sleep apnea in 2001 after feeling short of breath and tired during a trip to Las Vegas.

His sleep study found 72 interruptions an hour. Silenzio, 62, fits the traditional profile for sleep apnea. He weighs 360 pounds, he snored, and he didn't know he had a problem.

At night his wife would wake him, telling him he had stopped breathing. "I was incredulous. I thought she was just pulling my leg."

Now with treatment, Silenzio no longer falls asleep in the middle of movies. He isn't worried about dozing off while driving. And he doesn't have to get up several times a night to go to the bathroom.

It's not just overweight men who have sleep apnea.

Five years ago, a friend of Megan McMearty's pushed her to get tested for the disorder after noticing that she stopped breathing during her sleep.

"It really changed my life," said McMearty, 47, a bus driver for the Radnor School District. She says she has gone from being physically and mentally exhausted to the complete opposite. She went back to school and got certified as a massage therapist.

"I used to cry a lot, but now I feel content almost all the time," she said. "It is like I am not even the same person."

Here and nationwide, the number of women diagnosed with the condition between 1999 and 2003 rose faster than the number of men. Women now account for nearly 45 percent of the hospital patients found to have sleep apnea, an analysis of billing records shows.

My primary-care doctor sent me to Lugano after determining I might have mild sleep apnea because of my complaints of fatigue, occasional morning headaches, and midafternoon need for coffee.

I did not think I met the criteria for the disorder. I am not overweight, and I never really noticed an increase in my daily level of fatigue. Since I never heard myself snore, I did not think it was a big problem.

With treatment, the change has been dramatic.

I no longer wake to find my wife huddled on her side with a pillow over her head.

My weekends are my own again. Instead of arguing about my snoring, we joke about my heavy breathing.

And then we fall asleep.

Contact staff writer Josh Goldstein at 215-854-4733 or jgoldstein@phillynews.com.

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