A Battle for Breath: More Than Just a Good Night's Sleep

When Laurie O'Connell's husband learned that his lifetime of fatigue resulted from a severe case of sleep apnea, he saw an end to his sleepless nights. But a recent study linking sleep apnea and hypertension may sour his sweet dreams.

By Laurie O'Connell

My husband was 40 years old before he got a good night's sleep.

Throughout his childhood, "Sleepy Eddy" was always nodding off at inopportune moments. Within minutes of climbing into the family station wagon for an outing, his eyes would close and he'd begin to gasp fitfully. At church, his snores would rock the choir stall. He'd been sent home more than once for falling asleep in school.

Ed was always exhausted. Life became a constant, futile fight to stay awake. Yet no matter how long he slept, he never felt rested. In college, he was renowned for falling asleep during football training films. On tour with a major rock band, he fell asleep at the wheel barreling down New York's 6th Avenue.

Stressful slumber

Ed's fatigue was the most obvious problem related to sleep apnea, but this disruption of the most basic autonomic function has other repercussions. In the April issue of the Journal of American Medicine, a comprehensive study by F. Javier Nieto, M.D., at the Johns Hopkins School of Hygiene and Public Health in Baltimore revealed a compelling connection between sleep apnea and hypertension.

Researchers found that people with significant sleep apnea are 50 percent more likely to develop hypertension, a major risk factor in stroke and heart attack, than the general public. This risk rises with the severity of the sleep apnea, increasing from 43 percent for those who had fewer than 1.5 apneic episodes per hour to 67 percent for those who experienced 30 or more episodes per hour.

Although the study has been criticized because it does not firmly establish a specific causal relationship between sleep apnea and hypertension, sleep disorder experts like Meir Kryger, M.D. recommend that people who exhibit symptoms of any sleep disorder undergo evaluation for hypertension.

The mechanics of sleep

In the last 10 years, understanding of sleep disorders has greatly increased — at least one in four men and one in 10 women suffer from some form of sleep disturbance, including excessive snoring, sleep apnea, or the more rare narcolepsy.

The biology of sleep apnea is simple: The person with sleep apnea stops breathing repeatedly throughout the night. In each apneic state, the oxygen level in the blood plummets and the brain sends a desperate message to the lungs to kickstart the breathing process.

With a series of short gasps and finally a deep, shuddering breath, respiration resumes and oxygen levels rise, but soon another prolonged breathless episode ensues. Because most of these wake-ups do not elicit full consciousness, the person with sleep apnea, though exhausted from the night-long struggle for breath, may not be aware of the apneic episodes.

Sleeping with the enemy

Partners of sleep apneics are often the first to notice the problem.

I was shocked to find that Ed actually stopped breathing in his sleep, and did an informal clocking of almost a minute between breaths. All he knew was that he was "always tired" and had been told that he "snored like a trumpet," but after we read a magazine article on sleep apnea, we suspected that we'd discovered the real cause of Ed's exhaustion. All the factors fit: stocky build, large neck circumference, constant desire for sleep, and, most strikingly, the recurrent nocturnal breathing stoppages.

At a sleep lab, he was evaluated at 268 wake-ups per seven-hour period, constituting moderately severe sleep apnea. Soon after diagnosis, Ed underwent extensive facial surgery, including excision of portions of his palate and uvula, and reconstruction of his blocked nasal architecture.

Though surgery is no longer the treatment of choice for obstructive sleep apnea, Ed was fortunate – his surgery was an unqualified success. Within a few days, I noted a dramatic reduction in the number and duration of his apneic episodes.

Now he wakes up feeling rested and is far less sleepy during the day. He can sit through a movie without dropping off in the first five minutes, and I no longer cringe when he takes the wheel. He says that he feels truly alive for the first time, and, 11 years post-op, retains remarkable improvement in his symptoms.

Notably, Ed's only incidence of hypertension occurred in the immediate post-op period. Apparently caused by the stress of the surgery, it subsided within a few days.

Since then, his blood pressure has remained normal on sporadic testing, but the results of the new study gave us a heads-up, spurring him to seek re-evaluation last week. We were relieved to find his blood pressure within normal range, but, since he has some residual apneic episodes, plan to monitor his blood pressure more carefully.

Ed also has begun regular exercise, has modified his diet by becoming vegetarian, and has switched his radio dial from talk shows to music for stress reduction. We feel confident that, accompanied by regular checkups, these changes will help to maintain his blood pressure at a healthy level.

For millions of people with sleep apnea, restful sleep is an elusive goal. In addition to quality-of-life issues, the high risk of hypertension makes sleep apnea a serious disease. People with any sleep-disorder symptoms, including snoring or excessive daytime sleepiness, should schedule a complete hypertensive workup and implement lifestyle changes to reduce their increased risk of hypertension, including a low-fat diet, regular exercise and smoking cessation. More than just a good night's sleep is at stake.

A recent immigrant from rural northern California, Laurie O'Connell is a San Francisco-based writer and editor who is currently co-authoring a book on quonset huts. She can be reached at antbee@concentric.net.

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