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Tuesday, March 27, 2012

Sleep Apnea: The Noisy Killer

My previous post on Fitness had people asking me about Sleep Apnea.

Sleep Apnea occurs because our throats are a design compromise. In order for you to be able to speak well and articulate well, your throat should be as flexible as possible. However, in order for you to breath well, your throat should be as stiff as possible. Natural selection ended up with a compromise: your throat muscles hold your throat stiffly when you are awake, which means that the throat can be flexible enough so you can speak well. Unfortunately, when you're asleep, the muscles will relax, allowing the throat to collapse, which would cause an interruption of airflow. This is known as an apnea event if the interruption of airflow lasts longer than 5 seconds. A normal adult human would have less than 5 apnea events an hour. (In other words, if you have less than 4 events an hour, you don't have Sleep Apnea) Other than the throat collapsing, it's possible that your brain simply forgets to breath. That's called central sleep apnea, as opposed to obstructive sleep apnea.

The problem with being Asian is that Asians have smaller throats and smaller jaws. This leads to a higher probability that the muscles relaxing would cause a complete interruption of airflow. One doctor I spoke with told me that if you're Asian, it's not a question as to whether you'll have sleep apnea, it's a question as to when you'll get it. Women tend to have milder symptoms than men, and often don't develop serious symptoms until their 40s.

How do you know whether you're at risk? The big warning sign for me was my snoring. Snoring is basically your body pushing air through your throat in order to get air, vibrating the soft tissues and therefore making noise. My snoring was so loud that friends the next building over could hear my snoring when we were at Lucia. Otherwise, I was completely asymptomatic. Other people who've spoken to me about sleep apnea said they suffered the following symptoms:
  • Hazy and dazy in the morning.
  • Difficult to wake up or get up.
  • Lack of energy, lethargic, difficult to stay alert.
  • Grumpiness, especially in the morning.
  • Unusually rapid aging
Note that I had none of those symptoms when I was diagnosed, something my doctor said was common among Asians, especially fit ones. That's why I was not diagnosed for so long. It took a full on sleep study to discover that I really had 50-60 apneas an hour. (By the way, if your spouse is a snorer, you're should track these symptoms) The standard therapy for obstructive sleep apnea is CPAP (Continuous Positive Airway Pressure). Essentially, you wear a mask that pumps air into your throat to keep it open all night. Modern machines have algorithms that back off the pressure when you breath out so you don't feel like you've been pumped up like a balloon in the morning. You might also opt for surgery, but it's not for the faint of heart: they essentially break your jaw, move it, and stitch it back together, leaving you sucking food through a straw for a bit. I checked with one of the renowned surgeons in the area and he looked at my chart and said, "You respond really well to CPAP, you should try it before considering surgery." Now, if I had been symptomatic before, I'd have been super motivated to use CPAP. The overweight, obese, symptomatic people I've spoken to love their CPAP from day one, because for them, it feels like the fog in their mind was cleared away. For me, it actually seemed to make my sleep worse, and I woke up often with blisters on my nose where the mask chafed against my face, so I ignored it for almost a year. My doctor, however, got very concerned and called in the help of a sleep psychologist, who persuaded me to be more active about using CPAP therapy like this:
"Sleep apnea is like boxing. If you take a couple of hits in the face, it's no big deal. You'll recover and won't even notice. However, if you keep taking hits every day, it's all going to add up and you'll become slurry in speech and be unable to think well. Think about Mohammad Ali when he got old. In addition, it increases your risk of stroke, heart disease, etc."
That struck home, because my father had a stroke for no apparent reason in his early 50s. Ok, after that I became very motivated to use my machine. My sleep psychologist also helped a bit with finding the proper mask. Unfortunately, all the sleep studies seem to be done on Caucasians, so there're very few masks that will properly fit an Asian face, and custom masks just aren't done. And yes, I use the machine even when cycle touring, because I actually do spend a significant amount of my life doing this (or did before I had a baby). Now, if you have kids and you were diagnosed with sleep apnea, then you might be able to correct your kids' facial structure as they are growing so they don't end up with sleep apnea. It turns out that you need to start fairly young (at 1.5 years when you first take them to see a dentist is when you have to start thinking about it). Apparently it's like having braces, but for your jaw instead of just your teeth. The process can increase the airway area so collapse doesn't completely stop airflow. Which means that if you suspect you have apnea and have kids (or plan on having them), you really want to get yourself checked out. So that's as much as I know about sleep apnea. If you want to know more, let me know and I'll try to answer questions. And by the way, sleep apnea is one of those pre-existing conditions that cause you not to be able to get health insurance in California. Since about 10% of middle aged men have sleep apnea, that's a lot of people who would need Obamacare or some sort of group health plan in order to be covered.


Sy said...

There's actually PCIP now for Californa residents.

Pretty stiff conditions in that you need to be uninsured for 6 months and you need a letter from an insurer saying they refuse to cover you due to pre-existing conditions, but its not the pit it once was.

On the plus side, the premiums are competitive if not better than what the insurance companies would have been willing to offer comprehensive insurance at.

Piaw Na said...

PCIP is actually a result of Obamacare.

Andrew Gram said...

Thank you so much for this post. I made my wife go for a sleep study right after reading it, and sure enough she has fairly severe sleep apnea and is getting CPAP. Should make for a huge quality of life increase for her - even though she is really fit she could never get up early and always woke up exhausted.