8 Hours of Sleep Not Always a Night’s Rest : Apnea Sufferers Often Awake Tired and Stay That Way All Day Long
Eleven o’clock is “lights out.” The little room goes dark; the door closes. Benjamin Navarro has set aside his copy of the New Republic, and he lies back in bed, trying to get comfortable with 18 wires crisscrossing his body.
At 11:02 sharp, Navarro yawns. A needle swings wildly on a monitor humming softly in the next room. At 11:10 p.m., Navarro turns onto his left side, and a half-dozen needles jerk in response.
This night will be like no other for Navarro, a 32-year-old computer programmer from Carson, who dozes off by 11:18 p.m. For the next seven hours, his every breath, movement and heartbeat will be recorded as he spends the night in a sleep disorders laboratory tucked away in the basement of Torrance Memorial Medical Center.
He is here because doctors think he might suffer from sleep apnea, a disorder marked by loud snoring and interrupted breathing. Once considered relatively obscure, sleep apnea is stirring increased concern among physicians because it can cause severe daytime fatigue, high blood pressure, stroke and heart problems; serious cases can be life-threatening.
A study published two weeks ago in the New England Journal of Medicine reported that sleep apnea is more common than once believed. The study found that 9% of women and 24% of men had sleep-disordered breathing; 2% of women and 4% of men in the middle-aged work force met the criteria for sleep apnea. That would make undiagnosed sleep apnea “a major public health burden,” a Journal editorial stated.
Thus, as awareness of apnea and other sleep disorders mounts, suspected sufferers are spending their nights under an infrared camera’s watchful eye in hundreds of so-called “sleep labs” across America, sensors dotting their skin and scalp.
Depending on the severity of the apnea, treatment can include use of a nighttime face mask or even surgery. There’s a less high-tech approach for those who snore or suffer apnea only while on their backs: sewing a tennis ball in the back of their pajamas tops so they will sleep on their sides instead.
Not surprisingly, roommates and spouses are often the first to spot potential apnea victims. Navarro is a longtime snorer; he can remember his college roommates waking him to request that he tone it down.
His wife, Christine, grew worried when she noticed that he sometimes stopped breathing briefly during the night. She learned about sleep apnea from her doctor and urged her husband to get tested.
Although Navarro feels tired during the day, he pointed out that he has three young children, and that is enough to wear anyone down. Nevertheless, he decided to check in at the 12-year-old sleep center at Torrance Memorial, which treats people for sleep apnea, narcolepsy, insomnia and other sleep disorders.
The center can accommodate two overnight guests at a time, sleeping in rooms akin to small motel rooms with a blandly soporific decor.
Dress is casual. Navarro arrived shortly after 9 p.m. in gray warm-ups, stripping to a T-shirt and shorts so that technician Aida Rey could begin the painstaking half-hour process of taping sensors to his face, scalp, chest and legs.
“Are you going to be able to tell what my dreams are?” he asked.
No, she assured him; his dreams would be off limits.
But little else will be private after Navarro falls asleep.
In the next room, a video screen shows Navarro dozing peacefully. Pink computer paper moves steadily through the polysomnograph, a machine with 12 needles that records everything from his eye movements to heart contractions.
All night, Rey will monitor the needles’ black tracks, paying special attention to those measuring Navarro’s breathing. Sleep apnea victims have been known to stop breathing hundreds of times each night.
A technician woke him at 6:25 a.m. to remove the electrodes. Declining a hospital breakfast, Navarro went home to change before heading for his job in San Pedro.
He left behind a three-inch-thick record of his night that technicians and doctors would scrutinize in coming days.
Their conclusion: Navarro does not suffer from sleep apnea, although he experiences fragmented sleep because of breathing abnormalities. Next, Navarro will have X-rays done so that his doctor can learn more about the problem.
Another sleep lab patient, Pasadena resident William H. Chapman, was tested after his wife wrote his doctor to express concern about his restless sleep.
Chapman, 61, has been a heavy snorer for decades.
“The descriptions of my snoring went from something like a growling bear to a machine that was going to knock down the house,” he said. When he and his son went camping in southern Utah last year, his son asked him to sleep in the truck.
He felt bone-tired during the day, what he describes as “30 years struggling against this weariness that you feel perpetually. No alertness. No get-up-and-go.”
Four times he was behind the wheel of a car when he fell asleep. This winter, he was driving on Pasadena’s Del Mar Boulevard when he fell asleep again--and quickly woke up--finding his car headed for a tree.
Finally, earlier this year, Chapman spent a night at Torrance Memorial, plugged into the polysomnograph.
The test results were startling: According to Chapman, he was holding his breath as many as 57 times an hour, each time for 10 to 40 seconds. He would wake repeatedly as he held his breath, meaning that he unknowingly was sleeping only four or five hours a night.
His doctor, neurologist Dr. Lawrence W. Kneisley, diagnosed the problem as sleep apnea. “He had it bad, and he had suffered from it for a number of years,” said Kneisley, who is medical director of the Torrance sleep center. Like Chapman, many sleep apnea victims are totally unaware they have the problem, experts say.
In fact, a federal report released in January concluded that while 40 million Americans suffer from apnea, narcolepsy and other chronic sleep problems, the majority are undiagnosed and untreated. The report, from the National Commission on Sleep Disorders Research, estimated that in 1990, sleep disorders and sleepiness cost the nation at least $15.9 billion in direct costs alone.
“Despite their pervasiveness and impact upon our society,” the report concluded, “sleep-related problems are not recognized as a public health issue.” The report called for creating of a national center on sleep and sleep disorders, a plan under discussion on Capitol Hill.
Kneisley recalled that when he first started giving talks about sleep apnea, few people knew about the phenomenon. In fact, when he was in medical school 25 years ago, sleep was covered in a one-hour lecture.
But sleep problems are attracting far more attention today, judging from the legions of sleep-disorders centers that have sprung up in recent years. The American Sleep Disorders Assn. accredited only 26 such centers 10 years ago. Today there are 237. In all, the association estimates that 1,100 to 1,200 centers are operating nationwide.
The Torrance Memorial sleep center, which opened in 1981, was one of the first in the Los Angeles area. Now more than a dozen accredited centers are operating in Los Angeles and Orange counties.
Each month, 25 to 35 people sleep overnight in the Torrance Memorial sleep lab. Most are showing symptoms of apnea; others may be suffering from narcolepsy or other sleep disorders. An all-night evaluation costs $1,155, including the hospital fee.
Some patients, such as Chapman and Redondo Beach resident Dr. Gerald Looney, leave the center with what they were looking for: a good night’s sleep.
Both men were prescribed a type of therapy called “continuous positive airway pressure,” or CPAP (pronounced Sea-pap), in which they wear masks over their noses at night.
Since sleep apnea can be caused by constriction of the airway, the CPAP machine sends a steady flow of air through the mask and into the nasal passages, keeping the airway open and allowing the patient to sleep peacefully.
The result can be a dramatic improvement for sleep apnea sufferers. Chapman, who has been using the CPAP machine for more than six weeks, says he starts each day with new energy.
“I’d forgotten what it was like to sleep well,” he said. “I sleep through the night. I never wake up. . . . My eyeballs are now floating around in oil, and before it was like my eyes were in sand all day.”
Looney, 55, was fitted with a CPAP mask last month, and he talks about his new-found sleep with a teen-ager’s enthusiasm.
“Man, I tell you,” he said, “it’s kind of like getting younger again, all of a sudden.”
Sleep Apnea
Signs: The most common and severe form, called obstructive sleep apnea, features extremely loud snoring interrupted by pauses and gasps. Breathing stops for 10 seconds or longer, sometimes dozens or even hundreds of times each night.
Cause: Most frequently, the airway becomes blocked during sleep due to excessive relaxation of throat muscles. In children, sleep apnea is often the result of enlarged tonsils and adenoids.
Problems: People with sleep apnea may show signs of anxiety, depression, irritability, forgetfulness and fatigue during the day. Recent studies have found that sleep apnea sufferers have two to five times as many automobile accidents as people in the general population.
Treatment: Includes weight reduction (most people with severe sleep apnea are overweight); avoiding alcohol within two hours of bedtime and sleeping drugs; surgery to remove excess tissue at the back of the throat or enlarged tonsils and adenoids; use of a special mask that improves flow of air through nasal passages.
Sources: American Medical Assn. and American Sleep Disorders Assn.
