Stop Waking Up!

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Bill is a 60-year-old friend with prediabetes. For three years, he has been trying to control his blood pressure and lower his weight. He exercises, he eats a healthy diet. He even stopped drinking, but his weight, blood pressure, and morning blood glucose levels have stayed up.

Well, I saw Bill at a party last weekend, and he looked great! He was smiling and moving with energy. He had obviously lost at least 10 pounds. “What happened?” I asked.

“I’m fixed,” he replied happily. “They tested me for sleep apnea and found out I was waking up 20 times every hour to breathe. Two weeks ago, they gave me this little machine called a CPAP, and now I sleep through the night. I wake up feeling rested. Everything is so much better now.”

Is this your story?
Millions of people have sleep apnea (abbreviated SA, or OSA for “obstructive sleep apnea”), and most don’t even know it. When you have SA, your breathing tubes (“airways”) periodically become blocked and stop your breathing while you are asleep. You have to wake up and take a deep breath, thrash around, gasp, or cough to get the airways open.

The airways can get blocked up because fat cells in the throat have narrowed them, because your tongue or soft palate (in the back of the throat) has gotten larger, or because you have a small jaw that doesn’t leave enough room for the tongue. People with SA may wake up hundreds of times a night without realizing it. They may think they have woken to go to the bathroom, when actually it was the apnea.

SA has major impact on blood pressure, insulin resistance, cardiac function (including heart attacks), erectile function, and energy levels. It also seems to be much more common that we thought.

Even if you are diagnosed with SA, doctors are likely to tell you that your extra weight is the cause, and “just lose weight” is the answer. But, frequently, it seems to be the other way around. If you treat the SA, it becomes much easier to deal with the weight, blood pressure, blood glucose, and depression.

Do you have SA?
The main symptoms of SA are loud snoring, waking up feeling tired, and daytime sleepiness. People with SA may wake up with dry mouth, sore throat, or headache. If someone sleeps with you, he or she should be able to tell you if you snore—and may even have noticed if your breathing (snoring) sometimes stops briefly then starts again after you move around, cough, or gasp.

If you suspect you may have SA, ask your doctor for an evaluation ASAP. A physical exam may show if you are at risk. The examiner can see if you lack space between your tongue, uvula, and soft palate. But that won’t prove your breathing actually stops. The best way is to be tested in a sleep lab, especially if you don’t have a sleep partner who can inform the doctor how you sleep.

You can find a sleep lab near you at, and your doctor probably knows of one. Most people find sleeping in the lab an unpleasant experience. You will probably have electrodes attached to your skin to record your brain activity, heart rate, leg movements, oxygen levels, and breathing. This document describes what a sleep study is like. You will probably have a private room to sleep in, but will be observed through a window by a sleep technician. You should bring comfortable sleep clothes, toiletry items, and anything else you think you might need for an 8–12 hour stay.

Most health insurance plans will pay for sleep evaluation if a doctor orders it and documents the need for it.

Next week, we’ll get into all the self-management and medical treatments for SA. The condition is totally treatable, and treatment can make a tremendous difference in your life.

For now, what has been your experience? Do you think you may have sleep apnea? Has your doctor talked to you about it? What have you tried to deal with it? How is it going? Let us know by commenting here. You can also learn more about the sleep apnea–Type 2 diabetes connection in the article “Sleep Apnea and Type 2 Diabetes: A Vicious Circle.”

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