During the day, I was so tired my knees would buckle. Driving the car, my head would dip and then I would catch myself. My face was lined with exhaustion.
At night, I would sleep fitfully, legs churning, then snap awake with a start, gasping for breath, heart racing.
My doctor was puzzled. He ordered blood tests, urine tests, an electrocardiogram – maybe, he thought, the trouble was heart disease; those night-time palpitations…
No, my heart was fine. My blood was fine.
He ordered a colonoscopy. It was late 2008 and I was 47 years old – almost time to be having one anyway. So I forced down the four litres of Nulytely to wash out my intestines so a gastroenterologist could take a good look inside.
My colon was clean, the doctor told me when I regained consciousness. No cancer. Not even any worrisome polyps.
However. There was one thing.
“While you were under,” he said, “you stopped breathing at one point. You might want to check that out. It could be sleep apnoea.”
I had never heard of it.
Sleep is marked by dynamic changes throughout the body. It’s made up of different phases, and as you move through them, your breathing, blood pressure and body temperature will all fall and rise. Tension in your muscles mostly stays the same as when you are awake – except during REM phases, which account for up to a quarter of your sleep. During these, most major muscle groups ease significantly. But if your throat muscles relax too much, your airway collapses and is blocked. The result is obstructive sleep apnoea – from the Greek ápnoia, or ‘breathless’.MENU >
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One billion people worldwide stop breathing while they sleep. Are you one of them?
18
min
10 DEC 2019
Image:
© Karl-Joel Larsson at Acne for Mosaic
If you have sleep apnoea, chances are you don’t realise it. But it’s linked to diabetes, heart disease and other conditions, and it can put your life at risk.
Ithought I was dying.
During the day, I was so tired my knees would buckle. Driving the car, my head would dip and then I would catch myself. My face was lined with exhaustion.
At night, I would sleep fitfully, legs churning, then snap awake with a start, gasping for breath, heart racing.
My doctor was puzzled. He ordered blood tests, urine tests, an electrocardiogram – maybe, he thought, the trouble was heart disease; those night-time palpitations…
No, my heart was fine. My blood was fine.
He ordered a colonoscopy. It was late 2008 and I was 47 years old – almost time to be having one anyway. So I forced down the four litres of Nulytely to wash out my intestines so a gastroenterologist could take a good look inside.
My colon was clean, the doctor told me when I regained consciousness. No cancer. Not even any worrisome polyps.
However. There was one thing.
“While you were under,” he said, “you stopped breathing at one point. You might want to check that out. It could be sleep apnoea.”
I had never heard of it.
Sleep is marked by dynamic changes throughout the body. It’s made up of different phases, and as you move through them, your breathing, blood pressure and body temperature will all fall and rise. Tension in your muscles mostly stays the same as when you are awake – except during REM phases, which account for up to a quarter of your sleep. During these, most major muscle groups ease significantly. But if your throat muscles relax too much, your airway collapses and is blocked. The result is obstructive sleep apnoea – from the Greek ápnoia, or ‘breathless’.
© Karl-Joel Larsson at Acne for Mosaic
With sleep apnoea, your air supply is continually interrupted, causing blood oxygen levels to plummet. You then stir, gasping, trying to breathe. This can happen hundreds of times a night, and the ill-effects are many and severe.
Apnoea puts strain on the heart, as it races to pump blood more quickly to compensate for the lack of oxygen. Fluctuating oxygen levels also cause plaque to build up in the arteries, increasing the risk of cardiovascular disease, hypertension and stroke. In the mid-1990s, the US National Commission on Sleep Disorders Research estimated that 38,000 Americans were dying every year of heart disease worsened by apnoea.
There’s also growing evidence that the condition affects glucose metabolism and promotes insulin resistance – leading to type 2 diabetes – and encourages weight gain.
Then there’s the exhaustion of never having a full night’s sleep, which is associated with memory loss, anxiety and depression. Lack of sleep also causes inattention that can lead to traffic accidents. A 2015 study of drivers in Sweden found that those with sleep apnoea are 2.5 times more likely to have an accident than those without. It also fuels absenteeism, and people with apnoea are fired from their jobs more frequently than those without.
One study found that people with severe sleep apnoea were, all told, three times as likely to die during an 18-year period as those without.
But, as with smoking during the first decades after it was discovered to be lethal, there’s a disconnect between the harm that the condition causes and the public’s perception of it as a threat. “They fail to link sleep apnea with its many serious comorbidities,” says a report commissioned by the American Academy of Sleep Medicine, which estimates that it affects 12 per cent of US adults – but 80 per cent go undiagnosed. This prevalence is also found globally: nearly a billion people around the world suffer from mild-to-severe sleep apnoea, according to a 2019 study.
Research is now scrambling to catch up. Medical science has been working overtime to find a solution, from in-depth studies of hypoxia – how the body reacts to lack of oxygen – to new types of surgeries and appliances for treating the condition. But at the highest medical levels, interest is lacking. In the announcement that the 2019 Nobel Prize in Physiology or Medicine had been awarded for work on how cells adapt to changes in oxygen levels, diseases such as cancer and anaemia were mentioned, but the most common hypoxia-related ailment of all, sleep apnoea, was ignored.
Of the billion or so people across the globe struggling with sleep apnoea – most probably not even aware of it, never mind receiving treatment – I have deep psychological insight into just one: me. As the possibility that I could be facing an under-researched but potentially life-threatening health problem dawned on me, my central concern was simple: how can I fix this?Created by Wellcome
One billion people worldwide stop breathing while they sleep. Are you one of them?
By Neil Steinberg
18
min
10 DEC 2019
Image:
© Karl-Joel Larsson at Acne for Mosaic
Health Body
If you have sleep apnoea, chances are you don’t realise it. But it’s linked to diabetes, heart disease and other conditions, and it can put your life at risk.
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Ithought I was dying.
During the day, I was so tired my knees would buckle. Driving the car, my head would dip and then I would catch myself. My face was lined with exhaustion.
At night, I would sleep fitfully, legs churning, then snap awake with a start, gasping for breath, heart racing.
My doctor was puzzled. He ordered blood tests, urine tests, an electrocardiogram – maybe, he thought, the trouble was heart disease; those night-time palpitations…
No, my heart was fine. My blood was fine.
He ordered a colonoscopy. It was late 2008 and I was 47 years old – almost time to be having one anyway. So I forced down the four litres of Nulytely to wash out my intestines so a gastroenterologist could take a good look inside.
My colon was clean, the doctor told me when I regained consciousness. No cancer. Not even any worrisome polyps.
However. There was one thing.
“While you were under,” he said, “you stopped breathing at one point. You might want to check that out. It could be sleep apnoea.”
I had never heard of it.
Sleep is marked by dynamic changes throughout the body. It’s made up of different phases, and as you move through them, your breathing, blood pressure and body temperature will all fall and rise. Tension in your muscles mostly stays the same as when you are awake – except during REM phases, which account for up to a quarter of your sleep. During these, most major muscle groups ease significantly. But if your throat muscles relax too much, your airway collapses and is blocked. The result is obstructive sleep apnoea – from the Greek ápnoia, or ‘breathless’.
© Karl-Joel Larsson at Acne for Mosaic
With sleep apnoea, your air supply is continually interrupted, causing blood oxygen levels to plummet. You then stir, gasping, trying to breathe. This can happen hundreds of times a night, and the ill-effects are many and severe.
Apnoea puts strain on the heart, as it races to pump blood more quickly to compensate for the lack of oxygen. Fluctuating oxygen levels also cause plaque to build up in the arteries, increasing the risk of cardiovascular disease, hypertension and stroke. In the mid-1990s, the US National Commission on Sleep Disorders Research estimated that 38,000 Americans were dying every year of heart disease worsened by apnoea.
There’s also growing evidence that the condition affects glucose metabolism and promotes insulin resistance – leading to type 2 diabetes – and encourages weight gain.
Then there’s the exhaustion of never having a full night’s sleep, which is associated with memory loss, anxiety and depression. Lack of sleep also causes inattention that can lead to traffic accidents. A 2015 study of drivers in Sweden found that those with sleep apnoea are 2.5 times more likely to have an accident than those without. It also fuels absenteeism, and people with apnoea are fired from their jobs more frequently than those without.
One study found that people with severe sleep apnoea were, all told, three times as likely to die during an 18-year period as those without.
But, as with smoking during the first decades after it was discovered to be lethal, there’s a disconnect between the harm that the condition causes and the public’s perception of it as a threat. “They fail to link sleep apnea with its many serious comorbidities,” says a report commissioned by the American Academy of Sleep Medicine, which estimates that it affects 12 per cent of US adults – but 80 per cent go undiagnosed. This prevalence is also found globally: nearly a billion people around the world suffer from mild-to-severe sleep apnoea, according to a 2019 study.
Research is now scrambling to catch up. Medical science has been working overtime to find a solution, from in-depth studies of hypoxia – how the body reacts to lack of oxygen – to new types of surgeries and appliances for treating the condition. But at the highest medical levels, interest is lacking. In the announcement that the 2019 Nobel Prize in Physiology or Medicine had been awarded for work on how cells adapt to changes in oxygen levels, diseases such as cancer and anaemia were mentioned, but the most common hypoxia-related ailment of all, sleep apnoea, was ignored.
Of the billion or so people across the globe struggling with sleep apnoea – most probably not even aware of it, never mind receiving treatment – I have deep psychological insight into just one: me. As the possibility that I could be facing an under-researched but potentially life-threatening health problem dawned on me, my central concern was simple: how can I fix this?
While there are enduring risk factors for sleep apnoea – such as obesity, a large neck or large tonsils, a small jaw, or getting older – it doesn’t present itself until after an individual falls asleep. The only way to diagnose it is to monitor someone’s sleep.
So in early 2009, prompted by both exhaustion and the suggestion from my doctor, I made an appointment at a place called Northshore Sleep Medicine in Northbrook, Illinois.
I was met by Lisa Shives, a specialist in sleep medicine. She peered down my throat, then suggested I take a polysomnogram – a sleep study, where my breathing, blood oxygen levels, heart rate, and brain and muscle activity would be recorded.
I returned for this a few weeks later, on a Thursday at 9pm – an odd time for a medical appointment. It was dark outside.