Night Watch : More Weary Snorers Are Visiting Medical Test Centers as Awareness of Sleep Apnea Increases
Eleven o’clock is “lights out.” Benjamin Navarro sets aside his copy of the New Republic and lies back in bed, trying to get comfortable with 18 wires crisscrossing his body.
At 11:02 p.m., Navarro yawns. A needle swings wildly on a monitor humming softly in the next room. At 11:10, Navarro turns onto his left side, and half a 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. For seven hours, his every breath, movement and heartbeat will be recorded as he spends the night in a sleep disorders laboratory tucked in the basement of Torrance Memorial Medical Center.
Navarro is here because doctors believe that he may suffer from sleep apnea, a disorder marked by loud snoring and interrupted breathing.
Once considered relatively obscure, sleep apnea is causing increased concern among physicians because the condition can cause severe daytime fatigue and high blood pressure. Experts say that in some cases, sleep apnea can cause stroke and heart problems, possibly because a drop in oxygen can damage body tissue.
Sleep apnea is described as episodes during sleep when breathing halts for 10 seconds or longer. The person may repeatedly stop breathing, momentarily wake up, resume breathing and return to sleep, a cycle that can leave the sufferer exhausted but oblivious to the cause.
A study published recently in the New England Journal of Medicine reported that sleep apnea is more common than once believed. The study by researchers at the University of Wisconsin School of Medicine found that 9% of women and 24% of men stopped breathing at least five times per hour. As a result of their work, researchers estimate that 2% of women and 4% of men in the middle-age work force experience symptoms of sleep apnea.
That would make undiagnosed sleep apnea “a major public health burden,” a Journal editorial said.
And as awareness of apnea and other sleep disorders increases, suspected sufferers are spending their nights in hundreds of so-called sleep labs across America, sensors dotting their bodies.
Depending on the severity of the apnea, treatment may involve use of a nighttime face mask, wearing a mouth device similar to a retainer, or surgery to remove tonsils or alter the position of the jaw.
A more low-tech approach can work for those who snore or suffer apnea only while sleeping on their backs: A tennis ball sewn into the backs of pajama tops will remind sufferers to sleep on their sides.
Not surprisingly, roommates and spouses are often the first to spot potential apnea sufferers. Navarro is a longtime snorer. He recalls that his college roommates would wake him up to request that he pipe down.
His wife, Christine, grew worried when she noticed that he sometimes stopped breathing briefly during the night. She urged her husband to get tested for apnea.
Although Navarro says he gets tired during the day, he noted that he has three young children and that 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 accommodates two overnight guests at a time, who sleep in rooms with a blandly soporific decor.
Navarro arrived shortly after 9 p.m. Technician Aida Rey spent a painstaking half-hour taping sensors to his face, head, 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.
Later, a video screen in the next room shows Navarro sleeping peacefully. Computer paper moves steadily through the polysomnograph, a machine with 12 needles that records everything from Navarro’s eye movements to heart contractions.
Rey monitors the needles’ black tracks all night, paying special attention to those measuring Navarro’s breathing. Sleep apnea sufferers can stop breathing hundreds of times each night.
A technician wakes Navarro at 6:25 a.m. to remove the electrodes. Declining breakfast, Navarro goes home to change before heading to work in San Pedro.
He left behind a three-inch-thick record of his night for technicians and doctors to study. Their conclusion: Navarro does not suffer from the extended breathing interruptions that characterize sleep apnea, although his sleep is fragmented because of other breathing abnormalities. X-rays will be taken so that Navarro’s doctor can learn more about the problem.
Another sleep-lab patient, Pasadena resident William H. Chapman, was tested after his wife wrote to his doctor to express concern about Chapman’s 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.
He said he has spent “30 years struggling against this weariness that you feel perpetually. No alertness. No get-up-and-go.”
Four times he fell asleep while driving. Once, he jerked alert to find his car headed for a tree.
Finally, earlier this year, Chapman spent a night at Torrance Memorial.
The test results were startling: He stopped breathing up to 57 times an hour, each time for 10 to 40 seconds. He woke repeatedly, meaning that he was spending eight hours in bed but getting only four hours of sleep a night.
Neurologist Lawrence W. Kneisley diagnosed the problem as sleep apnea. “He had it bad,” said Kneisley, director of the Torrance sleep center.
Like Chapman, many sleep apnea patients are unaware that they have the problem, experts say. A federal report released in January concluded that although 40 million Americans suffer from apnea, narcolepsy and other chronic sleep problems, the majority of cases 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.
The report called for creating 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 condition. 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 increasing number of sleep-disorders centers. The American Sleep Disorders Assn. accredited 26 centers 10 years ago, compared to 237 today. In all, the group 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 have apnea symptoms, but others may suffer from other sleep disorders. An all-night evaluation costs $1,155.
Some patients, such as Chapman and Redondo Beach resident Dr. Gerald Looney, find what they were looking for: A good night’s sleep.
Both men received a type of therapy called “continuous positive airway pressure,” or CPAP, in which they wear masks over their noses at night.
Because 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.
The improvement can be dramatic. Chapman, who has used the machine for more than six weeks, said he starts each day with new energy.
“I’d forgotten what it was like to sleep well,” he said. “I sleep through the night.”
Looney, 55, was fitted with a CPAP mask last month, and he talks about his newfound 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 Once considered relatively obscure, sleep apnea is causing increased concern among physicians because it can cause severe daytime fatigue and high blood pressure. Experts say that in some cases, the condition can cause stroke and heart problems . * 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 dozens or even hundreds of times each night. * Cause: Most frequently, the airway becomes blocked during sleep because of the 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 car accidents as people in the general population. * Treatment: Recommendations include 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.
