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Each day for Milton Massie involved another battle to stay awake. He loaded up
on caffeine and went to bed earlier, but nothing he did seemed to help.
"I'd be sleepy in meetings; I'd drink 24 ounces of diet pop plus 24 ounces of
cappuccino daily to stay awake," said Massie, 48, of Chicago. "I'd be sleepy at
the oddest times. I tried going to bed earlier; that didn't work."
Then Massie's doctor referred him to a sleep disorders center where evaluations
revealed that he suffered from a common problem called obstructive sleep apnea.
This sleep disorder causes you to stop breathing up to hundreds of times per
night, ruining the quality of your sleep and causing excessive daytime
sleepiness.
Once sleep specialists determined the source of Massie's problem, they were able
to equip him with a more effective weapon in his fight against sleepiness:
continuous positive airway pressure.
Massie has now been using this treatment, commonly called "CPAP", each night for
about five years. The results have been both dramatic and far-reaching.
"I do sleep much, much better," he said. "My alertness around the office is
improved. I don't get sick as much because my immune system has improved. I
lost weight because I'm not eating to stay awake. I think I'm probably less
irritable too; my wife notices when I'm not on it."
According to Dr. Lawrence Epstein, president of the American Academy of Sleep
Medicine, Massie's experience with CPAP is common.
"Patients often express dramatic improvements in how they feel, often after the
first night," he said. "They are more alert, have more energy and are able to
perform at higher levels for longer periods of time."
First introduced as a treatment option for sleep apnea in 1981, CPAP provides a
steady stream of pressurized air to patients through a mask that they wear
during sleep. This airflow keeps the airway open, preventing the pauses in
breathing that characterize sleep apnea and restoring normal oxygen levels.
According to practice parameters published by the American Academy of Sleep
Medicine in the March 1 issue of the journal Sleep, CPAP has quickly become the
standard of care for treating moderate to severe cases of the disorder.
Dr. Patrick Strollo, director of the Sleep Medicine Center at the University of
Pittsburgh Medical Center, has been involved in the field of sleep medicine for
more than 20 years. He said that he prescribes CPAP for patients because of
both its effectiveness and its track record.
"Out of all the treatments that are available, such as surgery and oral
appliances, the bulk of research shows that positive pressure is the best
validated and most effective treatment," Strollo said. "Other options have a
variety of limitations."
Although some patients still may have difficulties using the treatment, success
rates are high. Dr. Nancy Collop, medical director of the Johns Hopkins
Hospital Sleep Disorders Center in Baltimore, estimated that 70 percent to 80
percent of patients see improvements to their overall health and sense of
well-being when using CPAP.
"It works. The biggest hurdle is getting people to wear it," she said.
Dr. Stuart Quan, director of the Sleep Disorders Center at the University of
Arizona in Tucson, agreed that the primary challenge is simply getting the
patient to put the mask on every night. Once that occurs, the benefit the
patient receives tends to become self-motivating.
"For people who actually wear the device, it basically changes their lives," he
said. "You have people who were sleepy and now they're not, who couldn't work
or carry-on daily activities and all of a sudden they can."
Strollo described some common side-effects such as nasal dryness or congestion
that may bother patients as they begin CPAP. He said that sleep specialists
expect to help patients overcome these problems during the initial weeks of
treatment.
According to Epstein, CPAP manufacturers have also developed new improvements
and features in recent years to make it easier for patients to adapt to the
treatment. The machines are smaller and quieter, connected humidifiers add warm
moisture to the air, and a variety of mask styles allow patients to find the
right fit.
Collop added that the high prevalence of the disorder is working in favor of
CPAP by boosting new patients' familiarity with the treatment. The American
Academy of Sleep Medicine estimates that 15 to 20 million Americans have
obstructive sleep apnea, although the majority of them remain undiagnosed and
untreated.
"There are a lot more people today that are aware of sleep disorders, and sleep
apnea in particular," she said. "They often have friends or family that are on
CPAP, so people have a better understanding of what it is and how it works."
Those friends and family members with sleep apnea are more likely to be men. The
American Academy of Sleep Medicine reports that men are twice as likely as
women to have the sleep disorder.
Although the classic sleep apnea patient is a middle-age, overweight man with a
large neck size, the sleep disorder can affect both men and women at any age
and any weight. The common symptoms, regardless of gender, are loud and
frequent snoring, choking or snorting sounds and pauses in breathing during
sleep, and severe daytime sleepiness.
For women, the risk of developing sleep apnea increases when they enter
menopause.
Althea Bates, 63, of Cleveland, described the classic signs of disrupted sleep
and daytime sleepiness that she experienced before starting CPAP in 1999 to
treat her sleep apnea.
"It was severe; I would be sleepy during the day and I didn't sleep very well at
night," she said. "I would find myself falling asleep in meetings. It took a
lot to get through the day."
Although there was a period of adjustment, she says that she quickly got used to
the treatment. Now she doesn't go to sleep at night without it.
"It has certainly increased the quality of my life, just the energy level and
being awake," she said. "I'm more alert and less tired. I use it nightly;
anywhere I'm going to spend the night, I take it."
As for Massie, the improvements in his sleep and daytime alertness have come as
a result of his long-term commitment to improve his sleep and his health by
using CPAP.
"I've been using it for four to five years," he said. "I've done everything the
sleep doctor told me to do."
Using CPAP is now one part of a healthier lifestyle that has made an impact on
his physical well-being. Although he had always maintained a daily exercise
regimen, in the last few years he also made a commitment to eat better.
As a result, he has lost about 50 pounds and 2.5 inches on his neck size. His
sleep doctor had to reduce the level of his CPAP air pressure to compensate for
the weight loss.
For Massie, the only downside to his CPAP treatment may be that he didn't start
it sooner.
"I probably had sleep apnea for 20 years and didn't know it," he said.
According to the American Academy of Sleep Medicine, the following list shows
common factors and warning signs for sleep apnea. Discuss these statements with
your doctor or a sleep specialist if any of them describe your health and your
sleep:
- You are overweight with a body mass index (BMI) of 25 or more
- You are a man with a neck size of 17 inches or more
- You are a woman with a neck size of 16 inches or more
- You have high blood pressure
- You are a menopausal or postmenopausal woman
- You snore loudly and frequently
- You make choking or snorting sounds during sleep
- You stop breathing during sleep
- You normally feel tired even after a full night of sleep
- You fall asleep while driving or during periods of daytime inactivity
- You have a family member who has sleep apnea
The American Academy of Sleep Medicine accredits more than 940 sleep centers
across the country. Click here to find a sleep center near you.
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