Written by Matthew A. Piacentini Friday, 10 December 2010 00:00
We all know that a good night’s sleep is important to feeling healthy, but one in five people might suffer from something called sleep apnea, which not only disturbs their sleep, but poses tremendous, even life-threatening health risks.
The warning signs of sleep apnea range from snoring or waking up in the night to a lack of focus or extreme tiredness during the day. Untreated, these symptoms can be signs of an affliction that elevates the risk of everything from high blood pressure, heart disease and stroke to diabetes. The effects can also lead to depression, anxiety, weight gain and sexual dysfunction. Some sufferers have trouble staying awake in important situations like while at work… or worse, behind the wheel.
Because of these significant risks, Long Island doctor Robert Rattiner urges any patients that show possible symptoms to do a test with their healthcare provider.
He says that there is good news for anyone concerned about sleep apnea – the test just got a lot easier and less intimidating. Traditionally, a patient would do a “sleep study” in a sleep lab, wired up and monitored for 24 hours. Now, in the interest of getting more patients to undergo diagnosis, technology is advancing to the point where you can do a similarly reliable study in the comfort and privacy of your own bed.
Dr. Rattiner shares that the most important thing about this development is the fact that so many patients are resistant to the lab test. “It is like pulling teeth to convince people to go,” he said. “For every one that agrees to go, four or five won’t do it and go on undiagnosed.”
As a board certified cardiologist and an internist, practicing privately since 1998 in Great Neck, Rattiner has a good grasp on the health risks across the board for these patients. He explained the basics on what sleep apnea is and why they should be concerned.
“Essentially, the body is going through suffocation,” he said. “When asleep, the muscles that keep your airways open relax and block the entrance of air into the lungs. What happens when air stops moving, is that no breathing can occur.”
The doctor said that people who have sleep apnea can experience this lack of breathing for anywhere from 10 to 15 seconds all the way up to two or three minutes. And, it can happen hundreds of times each night. To fight this, the body naturally works to wake you up. Some people are not even aware that they were awake all throughout the night. But, they feel un-refreshed in the morning and tired all day.
Even worse than the fatigue can be the fact that in order to wake you up, the body releases adrenaline. This has negative health effects.
Because of this, says Rattiner, “There is an overlap in my work in cardiology and internal medicine and primary care in general. I see high blood pressure and diabetes or palpitations or arrhythmia. The brain needs sleep too so you can see depression and anxiety. I also believe a lot of the fender benders you see on the road are undiagnosed patients... the people who find themselves nodding off in a lecture or at work, or while watching T.V.”
Another side effect can be dementia, he added. If you see older people getting confused, or showing personality changes or memory issues, sleep apnea is something to look into.
“People tend to think, ‘Well, grandma is just getting old,’ or ‘I had a senior moment,’” said Rattiner, “But that senior moment might be something you can address to improve your quality of life.”
He also said that many people who are simply said to have “died in their sleep” might have been undiagnosed. “If you fall asleep too long, you might not wake up. You can experience fatal brain damage from not breathing, or have a lethal arrhythmia. A lot of times when there is no ‘smoking gun’ of how someone died, I think sleep apnea is one possibility,” the doctor explained.
As mentioned, the diagnosis involves a sleep study. Whether you go to a lab or try the newer home device, a doctor needs information on how your body is behaving throughout the night.
In the lab, a patient is hooked up to equipment to monitor everything from their heart rate to brain function to oxygen levels. They are set up in a hospital or hotel type environment with a bed.
This is an important test but to many it is scary.
“It can feel like a science fiction movie,” Rattiner joked. “If someone has trouble sleeping to begin with, they can’t necessarily fathom sleeping in that environment in order to be tested.”
The newer device, with which the doctor has had more success, is less obtrusive and life altering. You can sleep in your own bed, with your oxygen level monitored on your finger and a vest worn over the chest that measures chest movements. Studies show that this is a viable and reliable method for diagnosis.
Whichever of the two options you go with, the important thing is to go for the study if you think you might suffer from sleep apnea.
The warning signs, as mentioned, start with snoring or stopping breathing throughout the night. They include depression, weight gain, sexual dysfunction, lack of concentration, fatigue or the tendency to nod off and the feeling that you are not refreshed after a night of sleep. Headaches in the morning are also a symptom, as the body is dealing with large amounts of carbon dioxide all night.
Obesity is a major cause of sleep apnea, as is smoking or simply aging, when muscles weaken in general. Consuming alcohol or sedatives can also cause sleep apnea because it relaxes the muscles that then obstruct the airways.
For some patients with a mild condition, losing a few pounds or cutting out the cigarettes or alcohol can help. Learning to sleep on your side can even reduce the obstruction in the airways.
In more severe cases, to combat the fact that oxygen is not getting into the lungs during the night, the main treatment for sleep apnea involves the use of a mask known as a CPAP. This forces air down into the lungs during sleep and allows you to exhale as well. Your doctor will use the sleep studies to gauge which pressure is enough to keep you breathing throughout the night.
Dr. Rattiner said that patients who go for the study and are diagnosed feel much better after the treatment. He shared that one younger male felt tired all the time and was confused about it, being a non-smoker in otherwise good shape. He even had a bad period zoning out once that led to a car accident. Once he strated sleeping with the CPAP, he noticed that he was not falling asleep while watching TV or feeling sluggish at work.
Another older male with prostate issues was convinced he was waking up all night because of the need to relieve his bladder. After convincing him to do the study, Rattiner said that it turned out to be sleep apnea waking him up, not his prostate, and he slept better throughout the night.
One patient, a 48-year-old male named Al, shared with us, “The testing was very easy. I was able to do it at home. Now that I have the CPAP every aspect of my life has changed. I have all of my energy, and I no longer fall asleep at meetings, which was very bad for my professional career, and I don’t fall asleep behind the wheel, which is deadly. It is amazing that sleep apnea can destroy your life, literally. I feel 10 years younger than I did before Dr. Rattiner diagnosed me. He saved my life, my career and even my marriage.”
So, if you feel like you might exhibit some of the symptoms mentioned in this article, don’t be afraid of the test. Ask yourself the questions we’ve listed in the accompanying box and talk to your doctor. You could improve how you feel on a daily basis, and more importantly, you might save your own life.
If you think you show signs of sleep apnea, answer these questions:
• Do you snore?
• Are you overly tired during the day?
• Are you “zoning out” or having trouble focusing?
• Do you suffer from depression, weight gain or sexual dysfunction?
• Have you been told you stop breathing while asleep?
• Do you have hypertension?
• Is your neck over 17 inches (men) or 16 inches (women)?
If the answer is “yes” to two or more, consider discussing symptoms with your doctor for a diagnosis. Untreated, sleep apnea can elevate your risk of high blood pressure, heart disease, stroke, diabetes and depression.