Sleep that knits up the ravelled sleeve of care,
The death of each day’s life, sore labor’s bath,
Balm of hurt minds, great nature’s second course,
Chief nourisher in life’s feast.

(Macbeth, Act 2 Scene 2)

Recent studies of Obstructive Sleep Apnea (OSA), one of the world’s most common human medical conditions, should raise alarm bells among the millions of people diagnosed with the condition, and the many millions more in the world who have symptoms but are not diagnosed. Untreated, sleep apnea can kill, and it can cause dementia.

As a person with OSA myself, the biggest recent medical research breakthrough is a study, published in the medical journal, SLEEP Advances, October 22 of this year. that confirms OSA causes Alzheimer’s disease and other forms of dementia in adults aged 60 to 84.

Women with known or suspected sleep apnea were more likely than men to have symptoms or a diagnosis of dementia at every age level. The study uncovered that by examining survey and cognitive screening data from more than 18,500 adults to determine the potential effect of known or suspected obstructive sleep apnea on the risk for dementia.

For all adults aged 50 and older, having known obstructive sleep apnea or its symptoms – as people often do not know they have the problem – was associated with a higher chance of having signs or diagnosis of dementia in coming years.

I was first diagnosed with mild sleep apnea in 2007 after an overnight sleep test in Owen Sound. I was not recommended for a CPAP (continuous positive airway pressure) machine. But another sleep test about five years ago led to a diagnosis of severe sleep apnea, and a prescription for CPAP. That’s been a struggle to get used to, and way too many times I took risks by not using the machine.

Earlier this year I purchased and began using a personal oximeter device to track blood-oxygen percentage level during sleep, with and without a CPAP machine. That small device has helped me understand the critical importance of blood-oxygen percentage levels, with the help of online information. I often find the Cleveland Clinic’s blood oxygen pages helpful.

Health Link BC has a clear and precise public explanation online of sleep apnea:

“Sleep apnea means that breathing stops for short periods during sleep. When you stop breathing or have reduced airflow into your lungs during sleep, you don’t sleep well, and you can be very tired during the day. The oxygen levels in your blood may go down, and carbon dioxide levels go up. It may lead to other problems, such as high blood pressure and heart disease.

“Sleep apnea can range from mild to severe, based on how often breathing stops during sleep. For adults, breathing may stop as few as 5 times an hour (mild apnea) to 30 or more times an hour (severe apnea).

“Obstructive sleep apnea is the most common type. This most often occurs because your airways are blocked or partly blocked. Central sleep apnea is less common. It happens when the brain has trouble controlling breathing. Some people have both types. That’s called complex sleep apnea.”

It’s important to add here that qualified medical providers should be consulted for expert treatment and advice.

There is a level at which the lack of oxygen can damage the brain and other organs.

I will say, it was a slap-in-the-face wake-up call one morning when the oximeter showed my blood-oxygen level had fallen to the low 80s percentages overnight when I had stopped using the CPAP machine because of the discomfort. I vowed then to use it religiously. I was not surprised when a few days later I coincidentally saw news about the study that confirmed sleep apnea causes dementia.

In 2023, in the U.S. the Count on Sleep partnership, a collaboration of several professional and patient-focused organizations, was set up to provide “an in-depth analysis of the symptoms, risk factors, prevalence, and burden” of OSA. The National Indicator Report found it affects nearly 30 million Americans, but estimated 23.5 million cases were undiagnosed. In an online public release, The American Academy of Sleep Medicine said “Untreated sleep apnea can lead to serious health consequences including disease, stroke, diabetes, and depression. (And now dementia can be added to that list). The Academy added the cost of undiagnosed OSA in the U.S. amounts to $149.6 billion annually “due to greater health care utilization, increased motor vehicle and workplace accidents, and reduced productivity.

“There are many barriers to sleep apnea diagnosis and treatment including insufficient awareness among the public and health care professionals. Health care professionals should recognize and address the signs of sleep apnea, and people who think they may have undiagnosed sleep apnea should talk to their doctor about their sleep,” the Academy said.

I thank my lucky stars I am a Canadian and that a modest income did not stop me from seeking medical help. The cost of overnight sleep tests, family and specialist physician consultation, and ongoing treatment equipment likely accounts for many of the six million people in the U.S. with undiagnosed sleep apnea. Yet even in Canada the available data indicates most people with the condition remain undiagnosed.

Canada’s Public Health Agency has not updated its information since 2013. A 2009 document, ‘What is the Impact of Sleep Apnea on Canadians,’ is still being used online. It says, “An estimated 858,900 (3%) Canadian adults 18 years and older reported being told by a health professional that they have sleep apnea. In addition to those who reported being diagnosed with sleep apnea, over 1 in 4 (26%) adults reported symptoms and risk factors that are associated with a high risk of having or developing (OSA).”

Sleep apnea has been called a “hidden health crisis.” That was certainly true when in 2019 a team of experts set out to study the worldwide sleep apnea problem. It found only 16 countries had “reliable prevalence data.” Using that data, and comparing countries with similar population and locations, they estimated 936 million adults aged 30 to 69 had mild to severe OSA, and 425 million with moderate to severe. The number of affected individuals was highest in China, followed by the USA, Brazil, and India. The study was financed by Resmed, one of the world’s largest makers of CPAP machines and other sleep apnea treatment products. It was published in The Lancet medical journal.

Do people who have sleep apnea die in their sleep because they’re breathing does not start again? It is said by many online sources to be uncommon. But the well-studied fact that people with undiagnosed sleep apnea especially will develop many other life-threatening conditions, like heart disease is well documented and studied. As the American Lung Association says, “There are serious potential consequences to undiagnosed or untreated sleep apnea. Besides making sleep difficult, it can lead to high blood pressure, heart disease, stroke, diabetes, dementia and result in early death.”

As far back as 2008 studies have shown people with sleep apnea and other sleep-disordered breathing problems were much more likely to die of ‘all causes,’ including cardiovascular mortality risks, especially if their breathing problems were undiagnosed.

My advice as someone with sleep apnea, if you are diagnosed, don’t give up on the CPAP machine: your brain, heart and life depend on it. And if you’re not diagnosed, but have symptoms, don’t delay: seek medical attention as soon as possible.