It had been years since Frank had woken refreshed. His wife, Helen, was losing sleep too. Not only was she worried about Frank's health, he was driving her crazy. Frank snored like a buzz saw. But it was the silence that kept Helen awake--the gaps between snores when Frank would go 10 to 20 seconds without breathing.

His fatigue affected his work and his driving ability, and it was turning him into a "grumpy old man," despite being only 45. Sure, he was a little overweight and knew that could be a snore-contributor, but who wants to jump on the treadmill when you're exhausted? Finally, Frank's doctor diagnosed him with sleep apnea.

What is sleep apnea?

Sleep apnea means loss of breath while sleeping. There are three types: obstructive, central and mixed, and according to the National Institutes of Health, the condition affects more than 12 million Americans annually.

Obstructive sleep apnea (OSA) is most common, and happens when soft tissue in the back of the throat relaxes, collapses and blocks the airway. Far less common is central sleep apnea (CSA), wherein the brain doesn't signal respiratory muscles to breathe.

Mixed apnea, a combination of the two, is when blood-oxygen levels decrease and the brain briefly wakes the sleeper so that she or he will breathe again--sometimes hundreds of times per night. That means the person is missing out on deep, good-quality sleep, the kind that promotes healing, cell-recovery, dreams, a sweet disposition and, of course, a happy partner.

According to the Mayo Clinic, the major risk factors for OSA are:

  • Being overweight--in particular, with fat deposits around your upper airway (though thin people can also develop OSA)
  • Having a neck circumference greater than 17 inches
  • High blood pressure
  • Narrow airway or enlarged tonsils or adenoids
  • Being male--though women's risks go up if they're overweight and post-menopausal
  • Being older than 65
  • Having a family history of sleep apnea
  • Using alcohol, sedatives, tranquilizers
  • Smoking
  • Sleeping at a high altitude

Additional risks for CSA include heart disorders like atrial fibrillation or congestive heart failure, stroke, brain tumor or neuromuscular disorders.

Screening, diagnosis and treatment requires referral from your primary care physician for a sleep study, with overnight monitoring either at home or in a sleep lab. According to the American Sleep Apnea Association (ASAA) a sleep study uses several devices to record activity during sleep. An electroencephalogram (EEG) measures brain waves; an electroculogram (EOG) measures eye and chin movement. An electrocardiogram (EKG) measures heart rate and rhythm; chest bands measure breathing movements; and additional monitors sense blood oxygen and carbon dioxide levels and leg movements. Though falling asleep when you're wired like a booby trap might be weird, nothing is painful and no needles are used.

Treatment options

Treatment varies depending on the type and severity of sleep apnea.

Positional therapy works for some with mild to moderate OSA. Since back-sleeping makes OSA worse, use a homemade device like a tube sock filled with tennis balls pinned to the back of pajamas, customized pillows or alarms to keep sleepers off their backs. Elevating the head or propping up extra pillows might also help.

Losing weight and avoiding sedatives and alcohol is recommended, but moderate to severe sleep apnea may require more aggressive intervention. Oral (or dental) appliances can keep the airway open by pushing the lower jaw forward, by preventing the tongue from falling back over the airway (a tongue-retaining device), or by doing both at the same time.

Some patients opt for surgery, though success rates aren't as high as with other treatment options, and sometimes the procedure makes the apnea worse. Surgery creates a more open airway to minimize obstructions; several non-surgical procedures also remove obstructive tissue or harden the soft palate by inserting polyester rods. The most common surgery is uvulopalatopharyngoplasty (UPPP), which enlarges the airway by removing or shortening the uvula, tonsils, adenoids, and part of the soft palate. It claims only a 40.7 percent success rate.

The most severe cases of OSA may require tracheotomy--surgery that creates a hole in the windpipe below the obstruction site. Effective but unpopular, tracheotomy is reserved for those who've tried and failed everything else. The hole is plugged by day for normal breathing and unplugged during sleep to bypass obstruction.

The CPAP approach

Continuous Positive Airway Pressure (CPAP), the most popular and effective treatment for OSA and CSA, gently blows pressurized room air through the airway to keep the throat open. The CPAP machine, which is about the size of a tissue box, connects to a flexible tube attached to one of a variety of masks, or face-devices. The mask is custom-fitted and comfortable, and air pressure is adjusted to individual needs. CPAP machines range from basic to totally tricked-out with computerized accessories.

Frank opted for CPAP. While he and Helen had a few laughs about how "hot" his mask made him look, the difference in his sleep life was profound. Helen reaped the benefits of snore-free nights, too, finally sleeping without noise or worry. Both soon became comfortable with Frank's new sleep buddy. Frank says, "I had no idea how much sleep apnea affected me. Now that I'm getting regular zzzz's, I'm sold. CPAP has saved my life." Helen thinks it's saved their marriage too.


Jeanne Faulkner

Jeanne Faulkner is a freelance writer and registered nurse in Portland, Ore. Her work appears regularly in Pregnancy and Fit Pregnancy, and she has contributed articles to the Oregonian, Better Homes & Gardens, Shape and other publications.