Apnea: The Sleeper's Worst Nightmare

Not so long ago, irritable, unproductive, and anxious sorts were simply regarded as grouches, laggards, and jerks. Now, growing numbers of us brandish medical diagnoses and pop record quantities of new drugs to battle depression, attention deficit disorder (ADD), and anxiety.

There's a chance, though, that some of us simply need more sleep. Increasingly, sleep specialists are discovering simple cases of sleep apnea--a blockage of the air pipe that disrupts sleep--among patients who are on medication for depression and ADD. This means that some people, adults as well as children, are taking drugs for the brain when what they really need is air in the lungs.

An estimated 5% of American adults, and 3% of children, suffer from sleep apnea. With each apnea episode, sleepers literally stop breathing, sometimes for as long as three minutes, until the body wakes them up for air. In severe cases, people are awakened hundreds of times during the night. Often, they don't remember these sleep interruptions. Doctors suspect that sleep apnea episodes trigger thousands of nighttime deaths, including heart attacks. And sleep apnea, along with other sleep disorders, certainly contributes to accidents, both in the workplace and on the road. According to the Journal of the American Medical Assn., 13% of automobile deaths are caused by people who fall asleep at the wheel.

GOES UNDIAGNOSED. Unfortunately, the symptoms--depression, sleepiness, grouch-iness--hardly distinguish victims of sleep apnea from the rest of humanity. That's why an estimated 90% of sleep apnea cases go undiagnosed. It's a "nighttime phantom," according to Jerry Halberstadt, who wrote a book by that name on the subject. Only now, according to Halberstadt, is the disorder making its way into standard medical curricula. Symptoms include morning headaches, loss of memory, high blood pressure, impotence, bedwetting, and irregular heartbeat. The American Sleep Apnea Assn. (202 293-3650) offers a newsletter, information about the various medical options and a list of local support groups. Or you can visit SleepNet's Web site (www.sleepnet.com) for more information.

Fortunately, sleep apnea does sound one loud alarm: Its victims usually snore. It is not a gentle, rhythmic snoring, but fitful and harsh, with long pauses (when the sleeper's not breathing) and violent starts (when the brain calls out for air). Apnea is caused by an excess of tissue at the back of the throat, which blocks the air passage. It is more likely to affect people who are overweight or suffer from allergies. Kids with oversized tonsils also are vulnerable. Other causes are anomalies in the throat or mandible, which shut down the wind at night.

Determining whether you suffer from the disorder is difficult. If you suspect apnea, visit your primary-care physician and push for a sleep test referral. Keep in mind that many doctors are slow to diagnose the condition of sleep apnea because they receive minimal training in sleep disorders in medical school. It may require some persistence to persuade your doctor to authorize such a test. "You almost have to drag them to get a referral," says Joseph Lavallee, a sleep apnea patient and chairman of the Manchester (N.H.) chapter of Awake, a sleep-apnea support group.

If the doctor agrees, you'll proceed to one of the country's 340 accredited hospital sleep centers for a full night of monitoring, which costs around $1,200. This involves sleeping while attached to sophisticated monitors, which measure the frequency of apnea episodes. Insurance companies and HMOs will usually pick up the tab, but they're likely to complain if they believe a doctor is overtesting.

There are two treatment options: Doctors can cut out throat tissue, as in a tonsillectomy; or patients can sleep with a machine that keeps the airways open. For children, doctors usually snip out the tonsils, which can solve the problem immediately. Sometimes, however, the obstruction is not as simple and requires more sophisticated surgery.

THE MASK. For nonsurgical cases, doctors usually will prescribe the Continuous Positive Airway Pressure unit and send the insurance company the bill. These are expensive six-pound apparatuses attached to hoses, which your insurer will either buy or rent for you. The hose is plugged into a mask that you wear over your face. The machine blows air down your throat all night long, creating an air splint, which holds the windpipe open.

Needless to say, it's not a great deal of fun. Some sleepers suffer claustrophobia from the mask. Some people have trouble exhaling against the current, and some complain of dryness in their nose and soreness in their throat. Not to mention the havoc a mask and air hoses wreak upon a person's sex appeal. Despite all these problems, doctors say, patients start feeling a whole lot better once they sleep through the night with a steady flow of oxygen.

The turnarounds are especially dramatic with children. But unfortunately, kids are terribly hard to diagnose with this ailment. Dr. Lewis R. Kline, a sleep specialist at Western Pennsylvania Hospital in Pittsburgh, says that children with sleep apnea sometimes appear hyperactive or easily bored--which hardly makes them stand out from the crowd. After school, they might act listless and sleepy. Parents who suspect a disorder should monitor their childrens' sleep for snoring.

Kline is among a handful of doctors who have had great success treating children already under medication for ADD using both the machine and surgery. He says the improvement in the children's spirit, behavior, and grades is dramatic. Kline also notes that sleep apnea is common among people with Down's syndrome. "Once they're sleeping well, their learning potential goes way up," he says.

People can also suffer from occasional sleep apnea, or partial blockage of the airways. Many, for example, snore loudly and fitfully after a night of drinking. The alcohol, in these cases, relaxes the throat muscles, causing them to flop onto the windpipe. Smokers can run into the same problem, because of inflammation of these tissues. Some people get relief by sleeping on their sides or stomachs.

It probably doesn't help much to recommend that people should stop smoking, cut down on alcohol, and lose weight. We've heard it all before. But if you do suffer from some of the symptoms, you might ask your loved ones to take the pillow off their heads and listen to your snoring. If they note a pause in your breathing, call your doctor.