I have sleep apnea, a condition that reportedly affects 2-4% of the US population. If I had not married my wife, Sandy, in 2001 I may have never had the incentive to have my “unusual” sleeping patterns checked out. I say unusual because I was completely clueless in regard to my “unusual” patterns. I mean heck I was sleeping, right? I always thought I slept really well, most sleep apnea sufferers do.
Obstructive Sleep Apnea (OSA) is not restricted to a particular gender and is associated with daytime sleepiness, cognitive impairment, hypertension, myocardial infarction (interruption of the blood supply to the heart), pulmonary hypertension (high blood pressure), and arrhythmias (irregular heartbeat). OSA is characterized by brief periods of interrupted breathing during sleep, and episodes can last from 10-30 seconds and recur at a rate of 400 times a night. A diagnosis of OSA is normally indicated by a Respiratory Distress Index (RDI) of over 5, (0-5 is considered normal). A mild RDI is as high as 20, 20-40 moderate, and over 40 severe.
I was in the 30-40 range, not good as my sleep study diagnosis said my episodes were upwards of 300 times a night, and I was completely unaware. Insidious, oh yes!
OSA occurs when the trachea (windpipe) is obstructed so that a person is unable to draw sufficient air into the lungs. The blockage may be caused by the person’s tongue, tonsils, or uvula (our little hanger in the back of our throats). It can also be attributed to fatty tissue in the throat. Frequently the first clue you may have developed OSA is from a sleeping partner who complains about snoring or long pauses in breathing patterns at night.
This, in fact, was my case. Sandy and I were married in 2001 and she has always had issues with uniformity in her sleep. She actually has had a sleep study and was not diagnosed with OSA but a condition called Disjointed Sleep. My becoming her sleep partner exacerbated this issue. As a classic snoring, flipping, moving, wild man something needed to be done. My sleep study confirmed her suspicions; I have OSA, and a relatively severe case. That being said, I never had any clue there was a problem. I always felt like I slept pretty well, so the news was very surprising. When I met with the doctor who specializes in sleep disorders he asked me a question I will never forget. He said, “Can you sit in a chair and just fall asleep?” I said, “Well yeah, can’t everyone?” His response was an emphatic “NO!”.
Did you know that it is reported that there is a two to seven fold increased risk in motor vehicle crashes due to OSA? Neither did I.
Reginald Howard “Reggie” White (December 19, 1961 – December 26, 2004) was an American college and professional football player who was a defensive end in the NFL for fifteen seasons during the 1980s and 1990s. He played college football for the University of Tennessee and was recognized as an All-American. The two-time NFL Defensive Player of the Year, 13-time Pro Bowl and 12-time All-Pro selection holds 2nd place all-time amongst career sack leaders with 198.5. He was also known for his Christian ministry as an ordained Evangelical minister, leading to his nickname, “The Minister of Defense.”
On the morning of December 26, 2004, White was rushed from his home in Cornelius, North Carolina, to a nearby hospital in Huntersville, North Carolina, where he was pronounced dead. White had suffered a fatal cardiac arrhythmia. The most likely cause of this, according to the Mecklenburg County Medical Examiner’s Office, was the cardiac and pulmonary sarcoidosis (a disease in which abnormal collections of chronic inflammatory cells, with an unknown cause) with which he had lived for years. It was also stated that sleep apnea, which White was known to suffer from may have contributed to his death. He was 43 years old.
To say I was shocked would be a massive understatement; we were exactly the same age. I am blessed to have married Sandy. Without her insistence of getting my sleep study done who knows what may have happened.
The average American has reportedly a yearly sleep deficit of anywhere from two hundred to five hundred hours. A National Sleep Foundation poll calculated that people sleeping eight or more hours a night dropped from 38% to 26% in 2005.
The function of sleep in addition to the duration and quality of sleep are all elements that are still being reviewed and tested. As we do not currently understand the totality of sleep function, there are still unknowns. We do know that a reduction in sleep causes fatigue, performance at a reduced level, with increased risks to our health and even mortality.
There have been many significant studies focused on the amount of time that has been shaved off our “normal” sleep duration, particularly over the last 20-30 years due to societal pressures such as increasing jobs or demands rather than biological changes. There have also been numerous studies from such sleep restriction activities such as lowered response times, lack of clarity in decision making, and even longer term health impacts.
One study from the National Health Interview Survey examined individuals from a wide range of occupations – everything from manufacturing to publication administration. They found that the percent of workers reporting sleep of 6 hours or less per night increased from 24 to 30% in the last 20 years.1
Not only is sleep necessary as for survival as good nutrition, and breathing, but it is vital for restorative healing and well-being. It is a critical component to brain health and learning. Rather than embracing our need for quality sleep, we seem to be finding more ways to do without it, notably the rise in energy drink consumption among our younger generations.
According to Mintel (a leading market research company) the energy drink market was valued at $4.8 billion in 2008, exhibiting 440% growth in current prices and 363% growth after measuring for inflation during 2003 to 2008. It forecasts energy drink sales increases by 63% in current prices and 40% in inflation-adjusted prices from 2008 to 2013.
Health Consequences of Diminished Sleep Duration
These findings are all listed at a magnificent white paper from the National Sleep Foundation at http://www.sleepfoundation.org/article/white-papers/how-much-sleep-do-adults-need, documenting the effects of a sleep duration of 4 hours a night for 1-2 nights for normal individuals.
- Increased heart rate and blood pressure2
- Increased inflammation (as measured by C-reactive protein which could be a potential risk factor for coronary artery disease3
- Impaired glucose tolerance (possibly a prelude to the development of diabetes)4
- Increased hunger/appetite (which could promote obesity)5
Sleep deprivation affects our quality of life (QOL) and well-being, and creates a state of chronic stress, affecting what is known as homeostasis in our equilibrium. In other words, balance is completely whacked. That is why the information from the National Sleep Foundation is so critical to grasp.
Lack of sleep triggers complex metabolic changes linked to poor food choices, cravings, and obesity. Scientific studies have shown that those people who slept fewer than five hours a night weighed significantly more than those who slept more than eight hours, a difference that is attributed to stress hormones cortisol, and appetite hormones Leptin and Grehlin, hormones that are critical to appetite and metabolism.
Technology has been driving the proverbial bus as an impetus for sleep deprivation, it is a vicious cycle. As with many of our 21st century health issues everything is interrelated. Sleep disorders are numerous and include not only sleep apnea and insomnia but also many more such as narcolepsy, somniloquy (sleep talking), restless legs syndrome, bruxism (clenching and grinding your teeth), night terrors and rapid eye movement behavior disorder.
So What to Do?
In my case, my sleeping partner helped encourage me to get the diagnosis and treatment I needed as I was completely unaware. For you it could be talking to your physician in an open dialogue. It could be a simple change for example limiting caffeinated drinks, alcohol or sugary foods. It could be an environmental solution such as a darkened room, and limiting exposure to television, computers, or smart phones.
The causes are many and the remedy may be simple. First you must understand what is at stake. While we still work to understand the full function of sleep, we do know sleep is vital to not only our quality of life but also to our very health. Take it from a guy who now sleeps well, I am sure that my journey of health improvement and weight loss has a direct correlation to Sandy finally saying “You need to get checked out.”
I did get that check up and I love her even more for potentially saving my life.
1 Luckhaupt SE, SangWoo T, Calvert GM. The prevalence of short sleep duration by industry and occupation in the national health interview survey. Sleep. 2010;33:149-59.
2 Tochikubo O, Ikeda A, Miyajima E, Ishii M. Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder. Hypertension. 1996;27(6):1318-24.
3 Meier-Ewert HK, Ridker PM, Rifai N, Regan MM, Price NJ, Dinges DF, et al. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol. 2004;43:678-83.
4 Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354:1435-39.
5 Spiegel K, Tasali E, Penev P, Van Cauter E. Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004;141:846-50.