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What Keeps You Up at Night?
Is it thoughts of your kids, your job, the bills on your desk? Is it that you simply don’t have enough time to sleep? Or might it be something more insidious that’s robbing you of your rightful rest? More men and women than ever before are being diagnosed with sleep disorders. And while the genders experience these disorders in roughly the same numbers, it’s sleep apnea—a serious disorder where a person’s breathing is disrupted during sleep—that can give rise to the greatest risk for stroke.
“There’s no question that sleep apnea affects more men, statistically. Nonetheless, we find an increasing number of post-menopausal women presenting with insomnia as the principal complaint when underlying obstructive sleep apnea is present,” says Federico Cerrone, MD, system director of the Atlantic Health Sleep Centers at Overlook Medical Center, Morristown Medical Center, and Goryeb Children’s Hospital. Snoring is a hallmark of sleep apnea, and Cerrone points out that 60 percent of men do snore—yet not everyone who snores has sleep apnea. Obesity is a contributing factor, too, and while the majority of sleep apnea patients are obese, approximately 25 percent are not. No matter the root cause, it results in a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep. This results in the telltale snoring (often very loud, indeed), as well as gasping, snorting, and frequent night wakings.
Diagnosing Sleep Apnea
“Most patients don’t know they have a problem,” says Cerrone. “Most problems are picked up by the man’s bed partner. If you ask someone if they snore, they say ‘No’ or ‘I don’t know.’ But that doesn’t mean they don’t.” Many sleep disorders can be diagnosed with a sleep study, where a patient is observed during sleep and monitors track such things as brain activity and heart rate. But the key to diagnosing sleep apnea is a good history. In addition to asking a patient if he snores or if he has been told he snores, the doctor will ask questions like:
- Have you been told you stop breathing while you’re sleeping?
- Do you wake up gasping at night?
- Do you have high blood pressure?
- Do you sleep but don’t feel refreshed?
Answering in the affirmative may well add up to sleep apnea, but there can be other problems too. It’s not uncommon for poor sleep to be the result of a metabolic disorder, a thyroid problem, or anemia, Cerrone explains. Sometimes problems are caused by medications a patient is taking. “That’s why we like to see patients first before just sending them for a sleep study,” he says. “If you’re snoring and you’re a large guy or if you’re a menopausal woman with weight gain and snoring, you may have sleep apnea and need to treat it.”
What’s the Damage?
Although patients with sleep apnea do frequently stop breathing for a few seconds while they sleep, the danger isn’t so much that a patient won’t wake up. Instead, the real problem is usually that something else happens as a result of the apnea. “It sets off a host of other problems,” Cerrone says. Over time, he explains, sleep apnea can lead to an irregular heart rhythm, a diminished immune system, and high blood pressure—all of which can lead to metabolic disorders, an increased risk for diabetes, and an increased risk for stroke. “Sleep disorders need to be diagnosed and managed, just like any other disease state,” he says. Even among patients who escape the most serious complications, the effects of poor sleep and lack of sleep are unmistakable. Research supports that most adults require seven-and-a-half to eight hours of sleep, ideally. “Former President Bill Clinton recently underwent another heart procedure and said afterwards that his lack of sleep may be partly to blame,” Cerrone reports. “He says that he is now sleeping at least seven hours a night and adding more exercise. Research shows that adequate sleep can improve your heart health, and inadequate sleep is associated with high blood pressure, heart disease, and diabetes. People become accustomed to sleeping less. They think they’re functioning optimally, but they’re not.”
Achieving Safer Slumber
How do you know if you have mild, moderate, or severe sleep apnea? The true test is a polysomnogram at an accredited sleep center, to determine the severity of your sleep apnea. If you have mild sleep apnea, your doctor may tell you that behavioral therapy (like weight loss) is all you need to make you feel better. But for patients with moderate to severe sleep apnea, the best option is usually what’s known as a CPAP (continuous positive airway pressure) machine, which increases air pressure in the throat to prevent the airway from collapsing. “Our program follows patients closely,” Cerrone says of the CPAP protocols available through the Atlantic Health System Sleep Centers. “We educate patients on the usage and benefits of CPAP, set up patients with the machines and help them get acclimated, and monitor them closely. We have a high compliance rate.”