Sleep apnea blocks its victims from deep, restful slumber. The results go beyond life-sapping fatigue and dangerous daytime drowsiness, playing a role in everything from diabetes to heart disease to cancer. And while the stereotypical patient is male, that’s changing.
G. Wayne Miller Journal Staff Writer gwaynemiller
WEST WARWICK — During her worst spells of sleep apnea, Jenn Foisy was lucky to escape mishap. Many mornings she awoke exhausted, her mind cloudy, her body starved of true rest, and got behind the wheel.
“At the time, I was driving the length of [Route] 295 to work every day, and I would be falling asleep while driving down the road, actively clutching the wheel, saying ‘I need to wake up. I need to wake up,'” recalled Foisy, a special-education teacher and mother who has run marathons.
Blasting the radio and rolling the window down didn’t help. Deprived of the restorative power of proper sleep, her life was in danger.
“I can remember being at the bottom of the hill by Route 6 in Johnston, and the next thing I knew I was at the Warwick Mall exit,” Foisy said. “I have no idea where all those other exits went. You’re definitely behind a hazy screen. Nothing is crisp and clear.”
Characterized by repeated pauses in breathing during slumber, typically accompanied by loud snoring or gasping, “undiagnosed or untreated sleep apnea can lead to serious complications such as heart attack, glaucoma, diabetes, cancer and cognitive and behavioral disorders,” says the National Institutes of Health.
Sleep apnea can raise the risk of stroke and asthma and increase the risk of vehicle crashes. It can take the luster off life, and there is preliminary research suggesting it can accelerate aging.
While research has demonstrated that sleep apnea is more common in men than in women, other studies, including one in 2013 from the UCLA School of Nursing, show that women are less likely to be diagnosed with it. Nearly one in five women experience sleep apnea — but some 90 percent of those who have it have not been diagnosed.
Sleep scientist and clinician Dr. Katherine M. Sharkey, who specializes in women’s health research, understands this well.
“The poster person in someone’s head is a 60-year-old obese man. They’re not thinking of a young, marathon-running mom as someone having sleep apnea,” said Sharkey.
Nor, necessarily, are primary-care professionals, who may hear from their patients accounts less disturbing than Foisy’s perilous driving and draw different conclusions.
“Not everybody says ‘I’m falling asleep during my commute,'” said Sharkey, associate professor of Medicine and Psychiatry and Human Behavior at the Alpert Medical School of Brown University and the school’s assistant dean for Women in Medicine and Science.
“With some people, it is more mood or irritability, or they’re having trouble word-finding,” Sharkey told The Journal. “I think if a woman goes and says that to her primary-care doctor, they’re going to say, ‘Oh, you’re really stressed.’ Or they’re more likely to get treated for depression or something like that.”
Scientists today see quality sleep and proper circadian rhythm — essentially, the body’s 24-hour clock that regulates alertness and sleepiness — as a necessity, not an amenity. Apnea is one of several sleep disorders — insomnia, restless leg syndrome, and narcolepsy are others — that can prove harmful to men and women.
“In the past decade, rapid advances have been made in our understanding of the science of sleep and circadian rhythms and their essential role in health, well-being, safety, and productivity,” writes the Society for Women’s Health Research, headquartered in Washington. “The game changer is the mounting evidence that sleep and circadian rhythms regulate nearly all biological and behavioral processes, from molecules, single cells and [hormone] systems to whole body physiology and functions.”
In other words, poor or inadequate sleep can negatively affect the whole being.
Obstructive sleep apnea, which Foisy experienced, happens when a person’s upper airway becomes blocked, stopping or reducing the flow of air. Causes can include a person’s unique anatomy, or medical conditions such as obesity, endocrine disorders and some genetic syndromes. (“Central sleep apnea” occurs when breathing signals from the brain are not sent.)
Women lag men in recognizing and reporting for a multitude of reasons, according to Sharkey. For example, she says, “There’s the bias of, ‘Do I want people to know I snore? It’s not ladylike. It’s embarrassing.'”
Foisy overcame such inhibitions when she first sought medical attention in 2010, when she was a single mother with a 3-year-old. The condition was confirmed after a night in a Massachusetts sleep lab, during which her sleep patterns, brain waves, blood-oxygen levels and other vital signs were monitored. She began sleeping with a continuous positive air pressure (CPAP) machine, which keeps the airway open with a continuous flow of air delivered by tube to a face mask.
But that early-era device was loud, uncomfortable and cumbersome, and eventually Foisy stopped using it.
“Very primitive in terms of technology,” she said. “The mask was a challenge to fit right and cleaning was a pain.”
Years later, she met Sharkey in a social setting, and they became friends. The doctor persuaded her to resume treatment — with one of today’s smaller, quieter and smaller CPAP devices that are easier to transport and clean.
Sharkey practices at the Brown Medicine Sleep Center in West Warwick, which features two sleep labs. The word “lab” is something of a misnomer: while the sleeping body is indeed monitored, the space resembles a comfortable hotel room, with bed, television, wall art, night table, chairs and soft lighting. And it’s quiet.
Chris Ruzzo, registered polysomnographic technologist, is master of this realm. She has been monitoring people with sleep issues for almost 35 years, and during that long career has accumulated great wisdom along with her technical expertise.
“You brain is like a computer: it needs to defrag itself” during restful sleep, Ruzzo says. “With fragmented sleep, your body wants to wake you up. But your brain’s trying to say, ‘Hey, I need to do what I need to do.’ But your body is saying, “Hey, I need to breathe.”
There are no facile fixes.
As Ruzzo put it, “You can’t take a pill and call it a day.”
And while other treatments are sometimes indicated, a CPAP device is typically preferred. Ruzzo recalled the days when health professionals “treated people who were on ventilators because they were so ill” and spoke of the evolution of a CPAP machine from Goldbergian contraptions to today’s miniature versions.
“They have travel CPAPs that are the size of your cellphone,” she said.
Foisy has been a beneficiary, as evidenced during a recent trip that she, her son, and her partner and two of his young children recently took to theme parks in Florida.
“We were doing 10 to 15,000 steps a day, three kids running around, going through the parks,” she said. “I wore it every single night — and every single morning, I woke up between 5 and 6 o’clock on my own saying, ‘I’m done sleeping, I’m rested, I’m ready to get up and face the day.”
And not just vacation days, Foisy told The Journal.
“Boy, do I notice a difference when I don’t use it for a night or two,” she said. “I wake up in a haze, tired and begrudgingly starting my day — in contrast to this morning, when I woke up fully rested, ready to tackle the day after a full night of healthy breathing and sleep.”
Is it apnea? What to do?
Feeling depressed, anxious, irritable or impatient
Feeling tired, drained or lacking energy
Feeling sleepy or falling asleep at the wrong time or place
Forgetfulness, foggy or fuzzy thinking, trouble with focus and concentration
Frequent or loud snoring, gasping, or snorting sounds
Difficulty falling asleep or frequent awakenings
Restless sleep or changes in dreaming
Frequent bathroom visits at night
What to do
“Sleep apnea is treatable. It is important to start a conversation with your health-care provider to discuss whether you are at risk for sleep apnea or another sleep disorder.”
SOURCE: The Society for Women’s Health Research, https://swhr.org
For more information on apnea and other sleep disorders:
The National Institutes of Health, https://www.nhlbi.nih.gov/science/sleep-science-and-sleep-disorders
National Sleep Foundation, https://sleepfoundation.org
On Twitter: @GWayneMiller