The First Co-Conspirator: OSA

About 20 years ago, my then girlfriend complained about my snoring. However, it wasn’t the volume (which she described as deafening) that caused her the most concern. It was the gasping for breath, the snorting, the appearance that I was choking that got her upset.

 

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Image by McLac2000

 

Admittedly, I thought she was over-reacting but I went to see my doctor anyway. He sent me to an ear, nose and throat specialist who ordered a slew of scans and tests including a sleep study.

A sleep study is an extremely uncomfortable experience. You’re in a strange bed, with a strange pillow and trying to sleep knowing you’re being watched. You have goop on your legs, chest and head, within which some thirty or more electrodes are placed. The vast majority of the electrodes are all over your head which adds an uncomfortable weight. You fear moving in your sleep because you fear displacing an electrode. Yet the whole point is for you to sleep.

The sleep study revealed that I had Obstructive Sleep Apnea (OSA) so my specialist operated on me to fix the problem. My septum was repaired, my uvula was removed, my sinuses and nasal passages were scraped, the snoring went away, the gasping for breath stopped and all was good.

What I didn’t know, because I didn’t research it and my doctor didn’t tell me, was that the surgery has about a 25-30% success rate. Or, to put it another way, a 70-75% failure rate. I just went about my life, unaware that for the next 20 years the OSA was wreaking havoc with my body and my mind.

The name tells you that OSA is a sleep disorder. While you’re asleep, your muscles relax and something (your palate, tongue, uvula or a combination of all of them) collapses to create an obstruction in the back of your throat. This causes you to experience an apnea (defined as the cessation of airflow for > 10 seconds). This can happen dozens of times a night without you ever being aware of it. Some people have hundreds of apneas a night. Airflow is regained when your brain learns of the obstruction and causes you to shift your position or, in some cases, wrench yourself awake.

In my case, each apnea lasts for 18 seconds or more and I experience 70, or more, apneas every hour. In essence, each time I fall asleep, I end up choking myself for a cumulative 20 minutes every hour. I wake up each morning more tired than I was when I went to bed. Most mornings, I begin my day with a massive headache. Every day is spent in a sluggish haze. My body feels leaden with exhaustion and my thinking is unfocused. My memory is very much hit and miss. I’m also quite short tempered and irritable.

Additionally, the frequency of my apneas means that I, and many others who experience this disorder, never enter into the deep sleep needed to recharge. I don’t dream because I never fall into a deep enough sleep to do so.

Keep in mind that I wasn’t aware that the surgery had failed. The progression of OSA came back gradually. I thought I was tired because of too much work, or dealing with changing shifts, or too much coffee, or too much stress. So, I developed ways to function including a reliance on notepads to aid my memory. In time, I realized that these methods were becoming less effective. What I didn’t know, was why. Sadly, or fortunately (I truly don’t know which it is), it took something quite extreme to answer that why – a suicide attempt and my interaction with the resultant slew of doctors and counselors.

Just as Major Depressive Disorder is more than just sadness, obstructive sleep apnea is more than just a poor night’s sleep. The effects of OSA are substantial. There is an increased risk of stroke (the risk to men is increased threefold); type 2 diabetes (48% of type 2 diabetes sufferers have OSA); hypertension; and other ailments, including depression.

 

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In the U.S., the economic cost of undiagnosed OSA – from medical costs to treat related illnesses to OSA – related automotive and other accidents – is estimated to be well in excess of $10 billion annually.

Against all of this – the low success rate of surgery; the increased medical risks and associated medical costs; the increased economic cost – is a simple solution. The recommended treatment is a CPAP (continuous positive airway pressure) device. In essence, you wear a mask and inhale mildly pressurized air. The continuous pressure is calculated at the level needed to counteract the effect of relaxation and keep your airways open. You experience a reduced number of apneas and breathe all night long.

In my case, the pressure needed to counteract the obstruction is extremely variable so I was prescribed with an APAP (automatic positive airway pressure) device. Unlike the CPAP, the pressure I receive varies in response to my need. Yes, I now wear a mask while I sleep and my breathing during sleep may sound Darth Vaderish, but given the choice of continuing to choke myself, or not, coupled with all of the additional increased medical risks, I’d rather wear the mask. Ultimately, I’m looking forward to a good night’s sleep, waking up with no headache and feeling vital throughout the day.

For two wonderfully informative videos on OSA, please view Sleep Apnea Explained Clearly Part 1 and Part 2.

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