Breathe in. Breathe out. As we go about our daily lives, we don’t need this reminder – we simply do it. But what about when we are asleep? We assume we breathe normally, trusting our body to continue this most basic involuntary action.
For the estimated 26 percent of the population with sleep-disordered breathing, including obstructive sleep apnea (OSA), nothing could be farther from the truth. Obstructive sleep apnea, or simply sleep apnea, is a sleep disorder where breathing is briefly and repeatedly interrupted during sleep. For some of the most severe cases, breathing is disrupted up to 120 times per hour. During a sleep study a pause in breathing at 10 seconds or more is considered disrupted. And each occurrence can last anywhere from 10 seconds to two minutes.
In our waking hours, we can feel the consequences. Imagine holding your breath for 10-20 seconds every minute for the next hour. Eventually your body would resist, fighting for more air. Or your body would shut down, begging for more sleep as a natural response to the lack of oxygen.
Being taken seriously
Sleep apnea is often missed because it is mistaken for sleep deprivation, which is often viewed as self-imposed and even those who report frequent and loud snoring are often still not taken seriously. Sleep apnea is the most common cause of these symptoms.
What this effectively means is that for anyone with a possible sleep issue, risk of OSA needs to be considered, and if there is any risk of OSA, it should be screened for by Home Sleep Apnea Testing at a minimum. If OSA is present, it should be treated. If it is not present, then other sleep disorders need to be considered.
So why don’t we recognize the long-term health risks of lost sleep?
For too long, sleep apnea has been regarded as a “soft” and unimportant secondary disease. Because its primary symptoms include sleepiness and irritability, it can be dismissed as poor sleep choices by an individual and sleep apnea is much too often not considered in the clinical context. This flawed perspective compromises the importance of sleep itself. As the announcement for the 2017 Nobel Prize in Medicine indicates, we are only just beginning to scratch the surface of sleep-related research. Chronic circadian disruptions have now been linked to a complex network of health-related reactions. Sleep loss is not only associated with daytime sleepiness, increased accidents and injuries and cognitive impairment, but also numerous comorbidities.
People who sleep less than six hours on average — typical of sleep apnea patients — are much more likely to develop high blood pressure, high cholesterol, diabetes and obesity. These conditions together are known as metabolic syndrome. People who are sleep deprived have a slower metabolism and trouble losing weight. They are also more likely to suffer from depression, a range of mental health disorders, cancers, heart disease and neurological conditions.
Why sleep is crucial
While awareness among the general public of these diseases is high, the knowledge about sleep and sleep-related diseases remains relatively low. According to the National Institutes of Health, the available resources to fully develop the science of sleep and to treat individuals with sleep disorders is lacking.
Another reason sleep apnea remains stigmatized is that so many people do not even recognize that their sleep is impaired. Simply put, one in three Americans likely do not know they have a problem at all.
Adam Amdur, Chief Patient Officer at the American Sleep Apnea Association (ASAA), silently suffered with sleep apnea until being diagnosed at age 35. “For 35 years, my ‘baseline’ for good sleep was flawed,” Amdur says. “But I would have never known that until I experienced a good night of sleep. My old ‘baseline’ is now an indicator of a severe problem.”
Founded in 1990, the ASAA is a patient-led nonprofit organization that promotes awareness of sleep apnea, and more than 100 other sleep disorders, works for continuing improvements in treatments, advocates for the interests of patients, and brings together a community to share stories and advice. Amdur, and many of the sleep apnea patients involved with ASAA, describe life with sleep apnea as walking around in a fog, constantly falling asleep.
As secondary conditions emerge for these patients, they are treated accordingly but sleep is frequently overlooked as the common denominator. Patients describe how they treated and maintained their high blood pressure or diabetes for years, never knowing it was actually a secondary symptom of their sleep apnea. In fact, one of the prevailing symptoms of diabetes is extreme fatigue which may mask inadequate sleep, missing the existence of either sleep debt or sleep apnea. In children, sleep-disordered breathing is even more commonly misdiagnosed as the most frequent symptoms are hyperactivity and attention-related behavioral problems.
Removing the guise that missed sleep is “no big deal” is the first step in creating a culture that values the science behind sleep and its long-term impact on our health. So, take a deep breath today and sleep easy tonight. Your long-term health depends on it.