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Cynthia Massive was thankful that she sleeps deeply. As long as she went to sleep first, she usually would not be awakened by her husband Milton's loud snoring. If he was the first to fall asleep, however, she was in trouble.
A gentle nudge, or more often a firm elbow in the ribs, would get him to roll over, hopefully quieting his snoring long enough for her to get to sleep.
Milton, 48, of California, was unable to downplay the extent of his snoring or blame his wife for exaggerating its severity. During long conferences that they would attend together in other cities, attendees in adjoining rooms would often comment that his snoring came loud and clear through the walls during the previous night.
"He knew that he had a problem with snoring," Cynthia said, "but he thought, 'Well, that's just the way I am.'"
More than just a snoring problem
Although the snoring was a problem, Cynthia was bothered even more by how Milton would constantly fall asleep during the day.
"Initially, I just thought he had a problem snoring, or he just didn't go to bed early enough," she said. "So it was frustrating when he would fall asleep during conversations."
The problem was magnified during two-or-three-day driving trips to conferences. Milton's sleepiness became dangerous as he struggled to stay awake behind the wheel. This forced Cynthia to do most of the driving.
"He would fall asleep everywhere," Cynthia said. "He couldn't stay awake, and he couldn't drive for long distances, so it became a real concern about safety. That's when he went to the doctor."
His doctor referred him to a sleep disorders center where evaluations confirmed that his problem involved more than just snoring; he had a common but serious sleep disorder called obstructive sleep apnea.
Sleep apnea causes you to stop breathing a few times an hour or even hundreds of times in a night. It disturbs your sleep, disrupts your oxygen levels and causes severe daytime sleepiness. It has also been linked to other problems such as high blood pressure, stroke, and other forms of cardiovascular disease.
Recognizing the warning signs
The most common warning sign for sleep apnea is loud and frequent snoring. About one-half of people who snore loudly have sleep apnea, according to the American Academy of Sleep Medicine. The loud snoring is also accompanied by silent pauses when breathing stops and choking or snorting sounds when breathing resumes.
These were signs Cynthia had noticed, although she didn't realize the severity of the problem at the time.
"It was loud snoring, that's how I noticed it," she said. "It would wake me up, and it seemed like he had stopped breathing."
According to Dr. Alex Clerk, medical director of the Sleep Medicine Services Clinic in San Jose CA, the bed partner plays a critical role in the identification of sleep apnea symptoms. The person with sleep apnea is often unaware of the problem.
"There is a lot of denial that goes on," Dr. Clerk said. "The problem with sleep apnea is you only have it when you're asleep. They don't know what goes on with their breathing when they're asleep."
Although sleep apnea can afflict adults at any age, it is most common in overweight, middle-age men. According to Dr. Clerk, many of these men are likely to deny that they have a snoring problem if their bed partner brings it to their attention. This is why women should educate themselves about the other effects of sleep apnea.
"They need to point out the other symptoms they're noticing as well, the daytime sleepiness and lack of energy, or the high blood pressure and stroke," Dr. Clerk said. "They need to be educated on the other things that sleep apnea is associated with other than snoring and disturbed sleep."
The standard treatment for sleep apnea
Medical help is available to detect and treat sleep apnea, but patients have to take the first step of visiting their primary care doctor or a sleep center to seek assistance. Milton got the help he needed when his sleep doctor prescribed a treatment for him called continuous positive airway pressure.
Also known as CPAP, this treatment provides a steady stream of air to patients through a mask that they wear as they sleep. This keeps the airway open and prevents the pauses in breathing that disrupt sleep and cause health risks.
According to practice parameters published by the American Academy of Sleep Medicine in the March 1 issue of the journal Sleep, CPAP has quickly become the standard of care for treating moderate to severe cases of the disorder.
Once Milton started using his CPAP at home, Cynthia began to see benefits right away.
"Within the first week or so, he woke up feeling better," she said. "I think it affected his weight as well. With the CPAP machine, plus some progress with his weight, it helped him overall. We saw improvements that he was able to stay awake during the day; we saw improvements almost immediately."
After about five years of treatment, Milton and Cynthia continue to see how CPAP has improved his sleep, daytime alertness and overall health. He is more alert during the day, he is now able to do most of the driving on long trips, and he has even lost 50 pounds.
According to Dr. Clerk, their success story is one that is being repeated among many of her patients who use CPAP.
"There are definitely people that get a tremendous improvement, and I see that over and over again," she said. "They wonder why they waited so long. They should have listened to their wife."
Convincing your bed partner to get help
Here are some tips for how you can encourage a reluctant bed partner to get help if you suspect that he or she may have sleep apnea:
- Tell your bed partner when he or she has snored loudly, made choking or snorting sounds or stopped breathing during sleep.
- If family members, friends, or guests tell you that they heard the snoring, ask them to tell your bed partner. That way, you're not the only one pointing out the problem.
- Sometimes hearing is believing. You may need to record the sound of your bed partner's snoring. Play it back so he or she can hear how severe the problem is.
- Educate yourself about the many health risks involved with untreated obstructive sleep apnea. Share your findings with your bed partner.
- Bring attention to the daytime symptoms of sleep apnea that affect your bed partner. These include severe sleepiness and falling asleep while driving.
- Motivate your bed partner by focusing on the positive side of getting medical help. Most people who receive treatment for sleep apnea sleep better, feel better, and have more energy during the day.
- Tell your bed partner how worried you are about his or her health, how important it is to you that he or she gets help, and how relieved you will be to know for sure if he or she has sleep apnea.
- Tell your bed partner that he or she will have your full support no matter how severe the problem may be.
- Go with your bed partner to visit his or her primary care doctor. Ask the doctor for a referral to a sleep disorders center that has been accredited by the American Academy of Sleep Medicine.
- Encourage your bed partner to develop a plan for better health. In addition to getting help for any sleep problems, this should include regular exercise and a healthy diet
