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Dread Of Night

Sleep apnea is on the rise in the U.S., and despite treatments to maintain air flow, there is no cure-all.

February 28, 2011|Amanda Leigh Mascarelli
  • Sleep apnea -- a Greek word meaning "without breath" -- used to be a largely unrecognized condition, but the diagnosis is becoming much more common.
Sleep apnea -- a Greek word meaning "without breath" -- used… (Jose J. Santos / Los Angeles…)

As Americans' waistlines continue to grow, so does the number of people who aren't getting a good night's sleep.

About 2% of women and at least 4% of men suffer from obstructive sleep apnea, a condition in which the airway collapses and blocks breathing for 30 seconds or even up to a minute or two. The brain senses that it isn't receiving enough oxygen and sends a signal to the person to wake up. The awakenings are brief enough that people usually are not aware of them, but sleep is disrupted continually throughout the night, leading to daytime fatigue and drowsiness.

For The Record
Los Angeles Times Tuesday, March 01, 2011 Home Edition Main News Part A Page 4 News Desk 1 inches; 32 words Type of Material: Correction
Sleep apnea: An article in the Feb. 28 Health section about treatment of obstructive sleep apnea omitted the first name and affiliation of Sonia Ancoli-Israel, a sleep researcher at UC San Diego.
For The Record
Los Angeles Times Monday, March 07, 2011 Home Edition Health & Wellness Part E Page 4 Features Desk 1 inches; 29 words Type of Material: Correction
Sleep apnea: A Feb. 28 article about the treatment of obstructive sleep apnea omitted the first name and affiliation of Sonia Ancoli-Israel, a sleep researcher at UC San Diego.
For The Record
Los Angeles Times Monday, March 07, 2011 Home Edition Health & Wellness Part E Page 4 Features Desk 1 inches; 29 words Type of Material: Correction
Sleep apnea: A Feb. 28 article about the treatment of obstructive sleep apnea omitted the first name and affiliation of Sonia Ancoli-Israel, a sleep researcher at UC San Diego.

Sleep apnea -- a Greek word meaning "without breath" -- used to be a largely unrecognized condition, but the diagnosis is becoming much more common. The incidence rises with age: Experts estimate that it affects about 40% of people ages 65 and older. In women, the prevalence rises steeply after menopause. And as people get older, the throat muscles become more prone to collapse.

But age isn't the only factor. Being overweight more than doubles your risk of having sleep apnea, says Dr. Lawrence Epstein, chief medical officer at Sleep HealthCenters, a network of clinics based in Brighton, Mass. And the number of people being treated for the condition is climbing along with rising obesity: a 2005 study in the Journal of Clinical Sleep Medicine found that the average weight of women referred to sleep centers for treatment of a breathing disorder had increased by nearly 10% over a nine-year period and the average weight of men rose almost 5%.

In children, sleep apnea was traditionally associated with enlarged tonsils and adenoids or skeletal abnormalities, which can constrict the airway. But doctors are finding that more children are being treated for sleep apnea as a result of being overweight. Dr. David Gozal, a pediatric sleep specialist at the University of Chicago, says the percentage of obese children being treated for sleep apnea in his program has increased from 23% in 1995 to more than 57% now.

"We're now seeing it in young teens and even kids in the 7- to 9-year age range," says Dr. Meir Kryger, the director of Sleep Medicine Research and Education at Gaylord Hospital in Wallingford, Conn. Kryger says he has treated children as young as 4 for obstructive sleep apnea related to weight.

The problem is worrisome, and not only because getting a good night's sleep is critical for concentration and alert functioning at school, on the job and while driving. Sleep apnea also puts people at greater risk of heart disease, stroke, high blood pressure and diabetes.

When a blocked airway prevents oxygen from entering the body, blood vessels constrict and blood pressure rises as much as 25% to 30%, Epstein says. The activation of the sympathetic nervous system to make people wake up also increases the heart rate and blood pressure. What's more, sleep apnea causes hormone levels to change in a way that reduces the effectiveness of insulin, leading to higher blood sugar and potentially diabetes, he says.

In children, sleep apnea can slow physical and mental growth and make it more difficult to learn. Experts don't yet know whether kids with the condition face the same long-term health risks as adults.

In obstructive sleep apnea, the muscles in the back of the throat go limp and cause the airway to collapse, leading to labored breathing and loud snoring. When a person is overweight, fat tissue in the throat makes the airway narrower and even more prone to collapse. And since the airway reaches from the back of the nose to where the vocal cords begin in the middle of the neck, airway collapse can occur in multiple sites.

A person is diagnosed with sleep apnea if he or she has at least five apnea events per hour, accompanied by daytime sleepiness. But experts say that five events per hour is a fairly mild case. Many people suffer from moderate (15 to 30 apneas per hour) or severe (more than 30 per hour) forms of the condition.

"They might be waking up hundreds of times during the night," Ancoli-Israel says.

Some people have mild enough symptoms that the condition can be alleviated with minor changes, such as sleeping on one's side rather than on the back.

But for those with more stubborn cases, the most common treatment is continuous positive airway pressure, or CPAP. There are many versions, though they all include a mask hooked up to a machine that blows air into the airway, acting like a virtual splint to help keep it open. Some masks cover the nose and mouth, while others cover the nose only or use tubes to blow air directly into the nostrils.

When used properly, CPAP is extremely effective. A study last month in the journal Sleep found that after three weeks of CPAP treatment, patients with severe symptoms saw marked improvements in daytime sleepiness and fatigue.

But not everyone wants to wear a mask to bed. "It's not very pretty, it's not very sexy and it can be uncomfortable at first," Ancoli-Israel says.

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