Being able to go to sleep quickly was something I took pride in. I didn’t know that it was a symptom of sleep apnea.
It wasn’t so great that I would also fall asleep in the evenings while reading or watching television in my easy chair. Especially disconcerting was my tendency to nod off in the afternoons when I was driving an hour or more.
My doctor, a specialist in both endocrinology and internal medicine, told me that my ability to fall asleep quickly in these circumstances was quite normal. I was tired all the time, even though it was usually 10 hours or so from the time I went to bed until I got up.
So I asked my doctor to set me up with a sleep specialist. He discouraged me.
The only treatment that works for most people, he said, is a CPAP machine. CPAP stands for continuous positive airway pressure. A CPAP system delivers pressurized air, typically through a nasal mask, to prevent collapse of the upper airway during sleep. It is a sort of miniaturized vacuum cleaner blowing air into the nose. In fact, when an Australian researcher named Colin Sullivan invented the first CPAP in 1981, that’s precisely what the early pumps were.
My doctor didn’t think that a CPAP would help me, because he thought that only 5 percent of users could tolerate the device and the nose mask that goes with it. I went ahead anyway and proved him wrong.
Eventually I got an appointment to spend a night in a private bedroom at the local sleep clinic. The technician wired me up with more than a dozen electrodes and fitted me with a mask attached by a flexible tube to something about the size of a shoebox, the CPAP machine itself.
Later when the doctor who ran the clinic gave me the report on that night, my statistics were grim. It showed that I have “very severe sleep apnea.”
The report continued. “Very loud heroic snoring was noted. REM sleep…was severely fragmented.” My sleep study showed that I had 82 apneas per hour, averaging about 24 seconds each.
“Apnea” is a Greek word meaning “without breath.” The clinical definition is a cessation of breath that lasts at least ten seconds.
The doctor in charge of the clinic told me that the statistics on compliance rates far exceeded what my first doctor believed. He said that nationwide 70 percent of patients tolerate the device and that in his clinic 90 percent did. My review of the professional literature confirms the national statistics.
My guess is that compliance is generally so good because the alternative is so bad. It is immediately obvious that you sleep much better. But untreated sleep apnea is also a potentially life-threatening condition. It can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Furthermore, untreated sleep apnea can led to automobile and other accidents.
Medicare and most health plans cover the cost of CPAP treatment and equipment. That’s a good thing, because in my case at least the bill would have been about $2,500 without insurance.
My compliance with CPAP use has been 100 percent. Ever since I got my device months ago I have never slept without it.
Sleep apnea is all too common and all too undiagnosed. In its 1993 Wake Up America report to the Congress, the National Commission on Sleep Disorders estimated that about 20 million Americans suffer from sleep apnea. The report estimated that only about 10 percent of those of us with sleep apnea knew what caused their excessive daytime sleepiness or other symptoms.
I am hardly the only person with diabetes to benefit immensely from using a CPAP machine. While a broad cross-section of the population has sleep apnea, those of us who have diabetes are much more likely to have it.
One study concluded that adults who suffer from obstructive sleep apnea are three times more likely to also have diabetes. Another study found that about one in four people with diabetes and neuropathy also have sleep apnea.
Both diabetes and sleep apnea are characterized by insulin resistance. And several studies have found that CPAP treatment significantly improved the insulin sensitivity of people with diabetes.
“I’ve lost more than 35 pounds and have gone from that sleepy guy in the corner to a top performer at work,’ writes a correspondent named Bill who also has diabetes. “Sometimes I don’t know if that's good or bad. The more I do the more work I get. Once I get into a job it’s almost like I’m on speed. For a writer that might be a good thing but, for somebody like me working in a union factory you have to balance the enthusiasm. Still, the CPAP is the best thing that I could have done as a middle-aged man.”
Since I began CPAP treatment I haven’t had my regular A1C test. But because I am so much more active and my insulin sensitivity has certainly improved, I am sure my level is better than ever.
It has given me a whole lot more energy. I spend two or more hours less in bed at night. And I never fall asleep in my easy chair and no longer get sleepy behind the wheel.
Three of the best resources to learn about sleep apnea include:
American Sleep Apnea Association
Sleep Review magazine
This article originally appeared in Diabetes Wellness News, November 2004, pp. 1, 4, 8.
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