At least 40 million Americans suffer from chronic sleep disorders which can cause heart

disease stroke and even death T here nin t no way to find out why snoring on a nightly basi ~ its not that

a snorer cant hear himsel f snoreshy funny Ma rk Twaill Tom Sawyer Abroad In fact it might even be rlangerous

I SnOling is qu ite often a symptom of proshy

By MA RK DOYLE gmssivc sleep apnea syndrome a disorder that not only stymies s lumber but a lso

tS one of li fes mischievous little can have se rious effects on blood prcsshyironics As the accla imed Samuel L sw-e ri~k of cardiovascular disease ~ troke Clemens put it a rip-snortin snorshy and eveu mortality

e r can wake up a man that is in the next According to the National Commission block with a dipperfu l nf laudanum in on Sleep Disorders Research at least 40 him hut cant wake himselrup although million Americans each year suiTer from all that awful noise of his ain t but three chronic long- te rm sleep disorders inches from his own ears induding such diverse problems as apnea

Those of you who ~leep with a chamshy narcolepsy insomnia circadian rhythm pion log-sawcr know what he s talkin g disorder sleepwalking restless leg synshyabout Jolted awake every night by noisshy drome and REM behavior disorder es so as toni shing they defy humanity An additional 20 million to 30 million yo u re losing desperately needed s leep experience sleep- related problems And whi Ie the belowd source of your insomshy millions more get inadequate ~ lcep

nia is ly ing next to yo u sawing down because of demanding work schedules enUre forests like Paul Bunyan and sleepshy stress and other lif~stylc factors ing through it like R umpclslillskin The com miss ion s findings are eyeshy

Aggravating Oh yeah Most oC us have opening In a reporl to Congress during had to deal with snoring at onc time or the mid- 90s the researchers found that another Generally we pass it off as one the consequences of sleep disorders sleep of those irri tating conditions some deprivation and s leepiness include fo lks j ust seem to have We even conshy reduced productivity incea~d likelihood sider it mildly humorou once we re of accidents and a higher morbidity and away from it But to those who live with mortality ri sk They al so span almost

Sam Hashimoto wears CPAI device to controt apnea symptoms and Ol rmger probe to monitor saturated oxygen levels

every aspect of our society transportashytion shipping manufactUling energy proshydUdion government military health care ed ucat ion and family and social lilc

The problems arc expensive as well The commission estimates that sleep disshyorders annually cost the United States a minimum of $15 billion in direct costs alone Subsequent studies place these costs at $16 billion Neither figure includes billions of dollars in related costs

mous Exxon Valdez oil spill during which the severely sleep-deprived third mate failed to respond to simple clear signals to tum the vessel back into shipping lanes It also points to the space shuttle Challenger disaster countless motor vehishycle and trucking accidents and untold decreases of productivity in the workshyplace as contributors to the costs relatshyed to sleep deprivation

Physicians have desclibed more than for such things as sleep-related aecidents Lois GaUagbcr registered polyslmnograby technician studies a sleep tIlIcing

The report specifically refers to the infa- SEE PAGE 59

lu

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ife-threatening ack Of Sleep mOM PAGE 8

7U ~lecp liisorders but obstrucshytive olccp ~[lnea appears to be the rno~t com ll1 on and the mo~1 alJIIming An cstirnaled 1g million Am~ritans suf fer from the ~Ilnilitlon In Hawuii the estishymlt~ i~ amp10)1 10 10 percen l Accorliing to Dr James Pe1rce u nc urologi~1 and director of th Siraub S leep Disorders Center 70 0 80 pereent of the palien his clime sees arc lhagnosed with sleep apnea

First of all sleep apnea is a li fe-threutcning d isea e lL cnn kill yO ll Pearce SllItes SecomJ il interferes with personal and public safe ty causing serious injury and accidents on the road and on the job

ObstruGlive sleep apnea occur when air cannot flow in or ou t o r a persons nose or mou th although efforts to breathe conshytinue According to the Froedtert Center for Sleep at the Medical College of Wise on s in it usualshyly occurs in assoc inLion with fat buildup or loss or muscle tone wit h ag ing These change allow the windpipe to co llapse duri ng breathi ng when musc les rel ax duri ng sleep The conchshylioll is usua lly associated with louo sllori ng tho ugh not evCJyshyone who snores has the di~orshyder

During m ep isode of sleep pile Ihe person s ~nort inhale air CIt3tes suction that colshylapses the wi ndpipe The hardshyr they suck the tighter the seal

ThIS hlocks the air now 101 10 seconds to a minute while th ~lceping person struggllgt breathe

When the persons blOt)d oxygen leve l fall s the brail1 lesponds by nwnkcning the pershySOil cnough tt)tighten the upper airway muscles and JCmiddotopcn thc windpipe The person may omon or gasp then rcsume snoring These episodes are cal led arousals anll theyre not the fun k ind

Whm happens is a person with sleep apnea is constantly awakshyened by these nrousals someshyti mes up to 100 ti mes an hour But it s j ust the body waking itselfup to brell the T he person never knows they happen They may thin k they got 12 hours of s leep but in fact barely got any Without reaching a deep restorashytive s leep ~tate they often wake up irritable and are cxce~sivcshyIy sleepy throughoul the day

Sleep apnea occurs in all agc groups and both sexes but is more common in men and posshysi bly young African Arnericam Four percent of middle-aged men nnd 2 percent of middle-aged women in UIC United States have sleep apnea ulong wi th excesshy~ ivc daytime s leepiness

when dream ing normally OCCLlrs McKea~ue now in hi s late

60s says I~cd never had a dream herore being treated ror s leep apnea I kept wonde ring whot everyone was tnl king about when they tal ked about their dreams he says Now I know

Not everyone however is all that thlilled with the CPAP treatshyment Bryan Hefner who was diagnosed with sleep apnea six years ago say~ he doesnt always use the machine because he finds it ullcomfoltable

hate it Hefner says straight out You have to have this hose hoo ked up and this mask It s restricting

Hefner used to travel for business and says he didnt like taking hi s CPAP on trips with him Says he found it embarshyTUss ing

r only use it when I gain weight or when Im feel ing low on enelty be explains Tm 235 pounds now but w hen I ge t up to 255 pounds I really noti ce a difference The machine give me more energy I should probshyably use it m ore than I do

Back to snori ng While snurshying is a common symptom of sleep apnea treatmen t for snorshying is not the same as treatment fo r apnea

There an several way~ to treat s nori ng says B Tucker Woodson MD a professo r of ololuryngo logy at (he Medical College of Wisconsin One is lifesty le modi ficati on things li ke losing weight treating allergies avo id ing th ings li ke a lcoho l and se da ti vc medica lion s A nother is pOS Itional therapy gelting people to sleep mon on the ir sides rat her th ln on Ulcir backs Good luck on that one

All ulOse nose s llips or sprays on the market rarel y work Woodson c lai ms and are n(lrshymnlly used in only the mildes t of cases

O f course theres a lways surgery which can stiffen and shorten the tissues of the throat But even these procedures aren t always effective

Snoring is a vibration of th e ti ssues of the throat so you can get rid of the vibration of Lhe tisshysues of the throat but not necshyessarily get lid of the blokage Woodson explains Theyre related but you can still have apnea even if you dont snore and you can get rid of the snorshying but not necessarily get rid of the apnea

Glad we cleared that up Remember if all else fail s and the snorer in your lift refuses to go under the knife you can alway~ give earplugs a try

r maybe go out and buy anoUlshyer pillow But don t forge I the pillow is for the cars nOl the mouth

People 1110st likely to have or stantiUle n higher prodivity fOi develop s leep apnea include sleep apnea among Pacifi c th ose who snore loudly and al so Islanders but he doc$n t disagree are overweight or have high wi th McNorton in his observashyhlood pnss urc or have some tinns

h applies an continuOllJ amount of The Sltn ub SIeltp DlsQrder Cepltr uses eleclrode~ to munitur e)c

movement chill uctivit) and nasW Wid orlll hrtltlhlng

phys ical abnormality in th nose throat or other parts of lIe upper airway It also seems to run in some Camilies suggC1 tshying a possible geneti c basis

In Hawaii where the incidence or sleep apnea is estimated to be hi gher than the national norm people of Pacific Is land ancesshytry appea r more susceptible to the condition says Dr Thomas McNorton a neurologist 3Jld leep spec ialist who runs the

Hawaii Center for Sle Medicine on Dahl

Pearce who in 1982 opened the Str~ u b Sleep Di sorde rs Center one of only two nati o nshya ll y accredi ted sleep centers in the slllte (the other is run hy McNorton) says there is no quantitative baseli ne data to subshy

We (ltd a contro lled s tudy in the 80s among n Tongan COlllshymunity and didnt fi nu llluch of a difference Pearce says But r think we need to do another one particularly in the Samoan community Clinically I see a 101 of S~rnoan patients

D r Edwaru Morgan a speshycialist in sleep disorders and pulshymonary medicine in charge of the Pulmonary S leep Disorders Ccmer at Kua ki ni Medical Center explains (hat IOda)s health -care industry operates on eviden ce-based medici ne meani ng if there isnt any quonshyll llllivc scienLilic proof Illen the -vidence doesn t ex ist

Having said thnt I would then say it is tm e Ihat Pacifi( Islanders are over-represen ted as patients

air pressure through a mask to k I f Ieep t le a irway rom c oSlllg

during sleep The CPAP dev ice has proven

to be an effec tive treatment for s leep apllla symptoms I preshyferred and less in trus ive option than surgery Accardi ng to McNorton surgical procedures are generally used when all other intcJVentions have fa ihd

La nikai resi dent Barney McKeague who was diagnosed with sleep apnea in 1992 opted for the CPAP device and still swears by it

The first day after wearing the CPAP mask I felt beller and for once didnt feel like I had to take a nap I also started dreoming

McNorton claims people with sleep apnea rarely dream because they seldom reach the mpid eye movement (REM) state of sleep

in our slcep ccnter Morgan agrees But we dont hlve sci shyenti fi c evidence that Samoans Hawaiians or Tongans are more susceptible to sleep apnea based on ethnici ty We do see more Paci fic lslandCJS but it is linked sole ly to obesity not ethnicity

Unfortuna te ly of the 18 milshylion people in the U nited Statcs estimated to have s leep apnea few are ever diagnosed We tell people to look for the com sympshytoms Pc1rce says If they snore choke gcp or hold their breath at nighl or if thcy re too sleepy duri ng the day they probably need laquo) be tested

If someone is overweight and experiencing any of these core apnea sym ptoms Pearce adds their risk for sleep apnea is increased drrunat icnlly

The first stcp is () bring it to the attcnlion of your plimruy care phys ician he says who would then re rer YOIl to a specia lized s leep c~nter Ihat can perform a lest called polysomnography Tilis test records the patien ts brain waves heartbeat and breathing us ually during an entire ni ght

If sleep apnea is diagnosed severaltrcatmcnts arc available Mild apnea frequen tl y can be overcome throug h we ight loss or by preven ting the person flltllTI leep ing on hi s or her back

Others may need special devices or surgery to correct the obstrucshyLion

H important to notc that peoshyple w ith s leep apnea ~hould never ta ke sedOlives or sleeping p ills which can p revent them rro m awakening cnough to h~1the

When hehavlor modifications a ren I eCrecti ve tile 1Il0st co mshymon prescrip tion for apnea i Cont inuo us Positive Ai rway Pressure (CPAP) The CPAP machi ne is a small pump that