CPAP

Death and Dementia: the ‘hidden’ perils of sleep apnea

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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.

The full face CPAP mask. Think lifesaver.

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.

The sleep apnea challenge: one man’s experience

/ findinghopeness / 2 Comments

As I began to look at the on-line news in the very ‘wee hours’ of this morning, The headline of a CBC Radio Canada article soon caught by eye: “Millions of people in Canada have sleep apnea. The problem is not all of them realize it.”

Indeed, “not all of them” was putting it mildly, when that was followed by this sub-heading: “Roughly 8 out (of) 10 with sleep apnea are undiagnosed.”

The article cites a 2014 study by Canadian medical experts. They cited information gathered by Statistics Canada indicating an estimated 5.4 Million Canadian adults had been diagnosed with sleep apnea or were at high risk of experiencing obstructive sleep apnea.

Sleep apnea is a condition in which breathing stops and restarts often many times during sleep. When that happens the heart has to work harder to keep pumping vital oxygen-rich blood to the body. Over time that can lead to heart problems. Meanwhile, there’s always the risk a person with sleep apneal won’t start breathing again.

Sunrise on Cathedral Drive is always inspiring. That’s my Shepherd, Buddy. Just because.

So, if someone says, or perhaps complains, you snore and gasp in your sleep, you may want to consider seeking medical advice; or also, if you experience other symptoms of poor quality, or lack of sleep, like excessive tiredness and lack of energy during the day. The latter has become the story of my life in the past year as I struggle, so far unsuccessfully, to master the art of using what the CBC article calls the “first-line, gold-standard” treatment for sleep apnea, the CPAP machine

More about that in a moment; but first, the basics. The U.S. National Library of Medicine has one of the best, brief descriptions of the two types of sleep apnea, obstructive sleep apnea (OSA), and central sleep apnea. OSA “happens when your upper airway becomes blocked many times while you sleep, reducing or completely stopping airflow. This is the most common type of sleep apnea. Anything that could narrow your airway such as obesity, large tonsils, or changes in your hormone levels can increase your risk for obstructive sleep apnea. Central sleep apnea happens when your brain does not send the signals needed to breathe. Health conditions that affect how your brain controls your airway and chest muscles can cause central sleep apnea.”

I get the impression central sleep apnea is a relatively new area of study, but to be honest I don’t know, and maybe my memory has failed me on this point; but I don’t recall ever being told which type of sleep apnea I have, despite having had three overnight sleep lab tests, all of them in Owen Sound. The last one was mid-October, 2023. So far there are no results, and no telling how long I will wait to hear from a specialist to discuss them. I waited a year after my second overnight test about five years ago. I take that to be a measure of the level of demand. When I had my first test, the technician told me I woke up briefly 40 times because I had stopped breathing, but I had no memory of that happening. Fortunately, my brain took charge and pushed the figurative ‘restart’ button. And that was called “mild, to moderate” sleep apnea.

After the second sleep test, I was prescribed to go on a CPAP (continuous positive airway pressure) machine, after a trial run of a week when it seemed to work for me. With a constant level of measured, pressurized air going from the machine to your airway, the system is designed to take keep you breathing if you stop. And you will, that is a given with sleep apnea.

But, despite the encouraging start, there was a problem, though the machine itself was working properly when tested. I tried different remedies, including going from a nasal to a full mask (nose and mouth) and still the problem continued: waking up after an hour or two with a very dry mouth and throat.

Turns out this problem, getting used to the CPAP machine, is not unusual: Forty percent or more of people who start, give up on it; but that should not be an option.

I confess I gave up for a while, but, realizing the risk I was taking, tried again, and again. And I’m still trying, as my sleep quality has continued to worsen. Recently, I bought an oximeter device, as a kind of ‘back up’ just in case. Made to fit like a ring on suitable finger, the device keeps track of blood-oxygen level and heart pulse. One of the risks of sleep apnea is that the heart has to work harder to keep pumping oxygenated blood when breathing stops. If the blood-oxygen level goes below a set percentage – I’ve set mine at 92 percent – the device has a vibration-alarm that is supposed to ‘gently’ alert you to restart breathing, but not necessarily wake you up. I’ve got the alarm set a ‘very strong’ but still it doesn’t consciously wake me up. Fair to say, I think, it’s not a good idea for the hard of hearing. So, time to get hearing aids after all, I guess, ASAP.

The ring-device comes with a smart phone or computer app which, when connected to the device shows the ups and downs of your blood-oxygen and heart pulse. That has been interesting and eye-opening, especially when the blood-oxygen level has gone below 90, before recovering, which has happened a few times. That’s troubling, but better to know than not.

To summarize, my sleep apnea has recently become life-changing: tired during the day, while trying to catch up by napping one or more times; and worst of all, lack of energy, having to push myself to get doing what came so easily even up to a year ago.

That’s not the way I want to live; but I am determined to find a way to overcome this sleep apnea challenge. And when that happens, I’ll be sure to let you know.