Why You Should Take Sleep Apnea Seriously
More deadly than once believed, the condition affects 1 in 5 older adults
En español | We all know that sleep apnea, not unlike a partner snoring in bed beside you, can easily disrupt a good night’s rest. Increasingly, the condition — defined as the repeated stopping and starting of your breathing while you sleep — is also being understood as a serious risk to your health.
Untreated sleep apnea has been linked to high blood pressure, type 2 diabetes, liver problems and possibly even dementia. Research has also shown that older adults with excessive daytime sleepiness and moderate to severe sleep apnea are more than twice as likely to die than those who don’t have it.
But despite these life-threatening risks, many aren’t even aware that they’re vulnerable. While more than half of people over the age of 65 are at high risk for obstructive sleep apnea, the most common type of the disorder, only 8 percent were tested for it, according to a recent University of Michigan study. “When people think of sleep apnea, they picture an obese male who snores, but this stereotype falls apart with age,” says Reena Mehra, M.D., a sleep specialist and the director of Sleep Disorders Research at the Cleveland Clinic. “Post-menopausal women, for example, have an increased likelihood when compared to premenopausal women.”
Sleep apnea is often overlooked because its symptoms can be subtle. “The most obvious signs are snoring and waking up gasping for air — or being told by your partner that you do this — but there are other signs to be aware of, such as not waking up feeling rested, a morning headache that dissipates after you start moving around, difficulty concentrating or just not feeling as sharp as you used to,” says Eric Olson, M.D., a sleep specialist at the Mayo Clinic in Rochester, Minn. If you’re having trouble getting blood pressure under control, even if you’re on multiple medications, that’s also a warning sign, he adds.
If any of the above signs sound familiar, ask your primary care physician to refer you to a specialist so you can be evaluated. Most of the time, a sleep test, or polysomnography, is conducted overnight at a sleep center. As you get ready for bed, a technician places sensors on your scalp, temples, chest and legs, as well as a small clip on your finger or ear. These are all hooked up to a computer so that the lab can monitor your brain waves, eye movements, heart rate, breathing patterns and blood oxygen levels as you doze.
If you’re wary of spending the night in a strange bed and being hooked up to an array of equipment (although some centers do them at hotels now, where you can snooze in luxury), then you can ask your doctor about possibly doing a home test. In this case, you’ll simply pick up a small portable monitor at your local sleep center and then put it on at home. (This usually involves placing a belt around your chest, attaching a clip to your finger and putting an airflow sensor in your nose.) When you return the device, the technician analyzes the results.
But keep in mind that such an at-home test will only pick up sleep apnea in the most severe cases. “If you’re a 65-year old overweight man who snores, and your wife reports you sometimes stop breathing and gasp for air at night, then you have a high likelihood of having obstructive sleep apnea. And it’ll show up on a home test,” Mehra says. “But if you’re a 55-year-old thin woman, it may be less clear, and a home test may be inconclusive.” In that case, you’re better off going to a sleep center for the test.
If you’ve got sleep apnea, lifestyle changes such as losing weight, avoiding alcohol before bedtime and quitting smoking can help. But the gold standard of treatment is continuous positive airway pressure (CPAP), in which a mask connected to a pump blows air into your throat to keep the airway open. If you wear one, a lot of the risks associated with sleep apnea can be dramatically reduced: A 2014 study published in the medical journal Sleep found that people who used a CPAP machine for just three months experienced a significant reduction in blood pressure.
But a 2016 review of studies published in the Journal of Otolaryngology – Head & Neck Surgery found that more than a third of all people prescribed a CPAP machine don’t stick with using one. “They can be uncomfortable to wear because they can cause symptoms like a stuffy nose or dry mouth. But if one mask doesn’t work for you, there are definitely other options,” Mehra says.
If you’re a mouth breather, for example, you may do better with a full-face mask that covers your mouth and nose. You can also opt for a CPAP-heated humidifier, which attaches to the air pressure machine to keep air moist, so you don’t wake up with a dry mouth. If you tend to get claustrophobic, look for a mask with a nasal pillow that fits under your nose so that it covers less of your face. “Like buying shoes, it can take a while to figure out the brand, size and style that you like,” Olson says. If you’ve tried several different masks and are still miserable, talk to your physician or provider about other options, such as a mouthpiece if you have mild sleep apnea, or even surgery if your apnea is severe.
Help for snoring
More than 37 million Americans snore regularly — meaning there’s an excellent chance that you or your partner keep one another up with awful buzz saw-like sounds. “As you get older, increased weight and/or decreased throat muscle tone can cause your throat to narrow during sleep and trigger snoring,” Olson says. Here’s how to find relief:
- Lose weight. Fat around your neck compresses your upper airway, triggering snoring, Olson says. Even shedding just five to 10 pounds can help.
- Sleep on your side. When you lie on your back, your tongue falls backward, blocking your airways. To keep from rolling back onto your back when you snooze, place a T-shirt stuffed with tennis balls or old balled-up socks alongside you.
- Elevate your head. Propping up the head of your bed by four or more inches can take pressure off your airway so that it’s easier to breathe while you sleep.
- Try an OTC nasal strip. If your honking is caused by a stuffed-up nose, nasal irrigation with saline before bed may help. Then apply over-the-counter nasal strips to help keep nasal passages open, Olson advises. You may want to consider adding a humidifier to your bedroom in order to keep the air moist. You can also try an OTC prescription steroid spray if you have chronic congestion due to allergies.
- Don’t nod off with a nightcap. Alcohol relaxes throat muscles, which can trigger snoring. If you want to enjoy an evening cocktail, be sure to close down the bar at least three to four hours before bedtime.
If your snoring doesn’t ease off despite these efforts and/or your snoring is accompanied by excessive daytime sleepiness (so you frequently find yourself nodding off, for example, when you sit down or even when driving a car), see your doctor to get evaluated for sleep apnea.