... about sleep apnea

By Anna Byk

When they got married over 35 years ago it took months before she was able to sleep through the grunts and snorts. But recently Stan's snoring has gotten worse. At times she's convinced he stops breathing for a few seconds before the snoring starts up again. She's also noticed that he's cranky during the day and often nods off while watching the six o'clock news, or worse, while driving. After much coaxing she finally got Stan to make an appointment with their FP.

Eliza's instincts were right — it wasn't normal for Stan to suddenly stop breathing in his sleep. Their FP recommended a visit to the sleep clinic. The sleep study revealed that Stan has sleep apnea.

Many Canadians suffer from sleep problems — sleep apnea being the most common disorder. About 4% of men and 1% of women over the age of 50 live with the condition. But many folks, like Stan Baffin, don't realize that their problem can pose a serious health risk.

As a primary care physician, you can nab sleep problems before they lead to other conditions like depression, sexual dysfunction, and learning and memory difficulties. Patients are also at a higher risk for hypertension, heart attack and stroke. Here are some tips on what to ask and tell your patients about sleep apnea.

A VISIT TO THE LAND OF NOD
• Catching some ZZZs "You should be asking all your patients if they're feeling rested and refreshed during the day or if they're feeling sleepy," insists Dr Michael Hawke, a professor of otolaryngology at the University of Toronto, and founder of the Silent Partners Sleep Clinic in Toronto. "If for any reason the patient isn't getting enough hours of sleep you can link that lack to all kinds of things." Patients who aren't getting their rest might be suffering from a host of problems like insomnia, restless leg syndrome, narcolepsy or sleep apnea. A proper sleep study will pinpoint the exact problem.

• Honey, are you awake? In many cases it's often the bed partners who are first alerted of any signs or symptoms of sleep problems either because their own sleep is disrupted or because they pick up on changes in behaviour. Bed partners are usually aware of any drowsiness your patients may be experiencing or if they're falling asleep during regular activities. They can also give you the FYI on your patients snoring habits and alert you if they stop breathing during the night, which is the first sign of sleep apnea.

• No sleep aids Patients should be informed that sleep apnea isn't caused by snoring — although it can be a sign of the condition. "A sleepy snorer has a higher chance of having sleep apnea than a non-sleepy snorer," explains Dr Hawke. But sleep apnea can only be diagnosed with a sleep study. Patients diagnosed with this condition should be advised to cut out alcohol, sedatives, tranquilizers and muscle relaxants. Dr Hawke also suggests that they should avoid sleeping on their backs.

• Behind the mask "For sleep apnea there's one terrible but effective treatment," says Dr Hawke. He's referring to a continuous positive airway pressure (CPAP) unit. Many patients won't be enthused by this treatment. The CPAP mask is similar to ones worn by jet pilots. It's cumbersome and many patients might not want to sleep with it. Greg Hasall, a respiratory therapist at Dr Hawke's clinic, suggests reassuring patients that the CPAP unit will make them feel better. This may encourage them to use the device. "There is a 50-50 split with patients," he says. "Some are really pessimistic and they don't really understand why the treatment works." Education is key to ensure compliance, he adds.