Lung health research
When snoring gets serious
An opinion piece by Dr. John Fleetham
Figuring out how to get a good night's rest can be exhausting. Many of us wake up tired every day, sometimes even after getting our eight hours of sleep. For some of us the problem may be sleep apnea -- a common condition many of us don't even know we have.
The other day, I met with a taxi driver whom I recently diagnosed with sleep apnea, a common disorder in which people snore loudly and stop breathing repeatedly while asleep. As a result of his sleep apnea, he is prone to falling asleep while at the wheel, so I told him that he should no longer drive. His response: “You can’t take away my licence – that’s my livelihood.” When I told him that there is an effective treatment which costs about $2,000, he replied: “I can’t afford that.”
Sleep apnea is a serious condition affecting one in 25 men and one in 50 women. Many people have it; but many go undiagnosed and untreated. Even if you don’t have it, the costs of sleep apnea to society affect us all.
Untreated sleep apnea can lead to serious health and economic problems. People with sleep apnea are at a higher risk for heart attacks and strokes, high blood pressure, depression, memory loss and excessive daytime sleepiness. Transportation accidents are caused each day by drivers with sleep apnea falling asleep at the wheel. Marriages have broken up and jobs have been lost, all for the lack of diagnosis and treatment of sleep apnea.
The most common signs of sleep apnea are loud snoring followed by silent pauses and daytime sleepiness. Bed partners or family members often pick up on these clues to sleep apnea first. Other signs include: morning headaches, irritability or mood changes, poor concentration or memory loss and lowered sex drive.
If you have sleep apnea, you are up to seven times more likely to have a car crash. You are three times more likely to have a heart attack or stroke. You are also more likely to have hypertension, depression and diabetes
If your doctor thinks you have sleep apnea, you should be referred to a sleep laboratory for a sleep study. This test, called a polysomnogram, will record your brain waves and breathing patterns while you sleep. To do this painless test, a sleep technologist will attach wires to your head, face, chest and legs.
However, it’s difficult to get diagnosed in some parts of Canada. If you’re lucky enough to live in Ontario, you have better access to polysomnography with relatively short waiting times. In the rest of Canada, access is rationed and you may wait 12-18 months for diagnosis. You’re completely out of luck if you live in Prince Edward Island, Yukon, Nunavut and the Northwest Territories – there are no sleep laboratories there. For every 100,000 people, 780 have access to polysomnography each year in Ontario, 130 in Quebec, 117 in the Western provinces, and 54 in the Maritimes. The discrepancy across Canada for access to diagnosis of sleep apnea is a cause for national concern.
The good news is that treatment is simple and very effective. If you have mild sleep apnea, your doctor may recommend lifestyle changes, such as losing weight, getting some exercise, quitting smoking, avoiding alcohol and sleeping pills and sleeping on your side.
If you have moderate to severe sleep apnea, your doctor may recommend several options. The most common treatment is continuous positive airway pressure (CPAP), which works by delivering a steady flow of air through a special mask to keep your airway open during sleep.
CPAP machines can cost up to $2,000, which is covered by the provincial health insurance plans in Ontario, Saskatchewan and Manitoba but not the rest of Canada. In other provinces, the cost may be covered by private health insurance. But if you lack private health insurance, like my friend the taxi driver, you have to pay out of your own pocket - a cost many Canadians can’t afford.
If sleep apnea is so common, its effects so potentially devastating, and its treatment so relatively simple and effective, then why isn’t there more being done about this debilitating disorder?
Well for one thing, many people who have it may be unaware that they do. According to the Canadian Lung Association, the average patient waits seven years between the onset of symptoms to the time they are referred to a specialist for assessment. So if you think you may have some of the symptoms, don’t wait. Talk to your doctor about it.
Another reason why sleep apnea goes untreated is that, unlike cancer and AIDS, it has a low public profile. Although many famous people suffer from sleep apnea, none have stepped forward as a poster child as loud snoring is not a glamorous symptom.
On April 28th, the Canadian Lung Association is hosting a Sleep Apnea Summit in Ottawa to develop a strategy to provide better access to diagnosis and treatment of sleep apnea for all Canadians. Perhaps then, some sleep-deprived Canadians will hear this wake-up call.
Dr. John Fleetham is a respirologist for the Vancouver Coastal Health Authority and its Research Institute. He founded and is co-director of the Vancouver Acute Sleep Disorder Program.