Waiting to Inhale

Sue Radtke's snoring had long been a family joke. The Madison resident snored so loud, legend has it, that her daughter was unable to sleep behind closed doors some distance from the bedroom Radtke shared with her husband--who, being even closer to the source, passed many a wakeful night himself.But Radtke's loved ones weren't the only ones lacking sleep. Radtke herself was always tired, no matter how many hours she spent in bed. "I was exhausted all the time," she says. "I was always being tested, and nothing was ever wrong." Such possible causes as anemia or depression were ruled out. Each time Radtke resigned herself to the idea that exhaustion was simply a busy mother's lot.Little did she suspect that her snoring was a clue to a more serious problem--until an ear-nose- throat specialist sent her home with a sleep-monitoring device. Sensors attached to her nose, mouth and chest indicated a disorder that more sophisticated in-hospital monitoring would later confirm: Many times during the night, Radtke's airway became so constricted that she not only snored, she actually stopped breathing for seconds at a time. She had been almost completely unaware of these nocturnal brushes with death. "Occasionally I'd wake myself up with snoring, or what I thought was snoring," she says. "In retrospect, I think I was really gasping for air." Radtke's disorder is called sleep apnea--"apnea" meaning "without breath" in Greek--and it is much more widespread than commonly thought. Groundbreaking studies at UW-Madison revealed that some 4% of women and 9% of men nationwide have apnea severe enough to warrant treatment.Breathless periods can last anywhere from 10 seconds to two minutes and can occur more than 100 times per hour.Typically the danger of apnea lies not so much in the individual breathless episode--although in rare cases a person will indeed fail to resume breathing--as in the disorder's long-term health consequences, says Terry Young, a professor of preventive medicine at UW-Madison. Repeated awakenings keep the body from getting enough deep sleep and can lead to chronic sleep deprivation. Apnea also wreaks havoc with the body's cardiovascular system, leading to greater risk for strokes, high blood pressure and heart attacks--not to mention car accidents, injuries or impaired performance at work, depression, poor concentration or memory, and other ills resulting from extreme daytime sleepiness. "The public-health consequences are widespread," warns James Sehloff, a pulmonary disease physician with Dean Medical Center. "They include not only injuries to the person experiencing apnea, but to other people as well."People suspected of having apnea may eventually find themselves in a hospital sleep lab for a night of heavily monitored rest--or tossing and turning, as the case may be. Sleep Disorder centers are experiencing a booming business. "We're growing exponentially," says Marcia Davidson, a clinical coordinator at the St. Marys Sleep Disorder Center in Madison, Wiscon. Last year some 900 patients, or "sleepers," as they're called, spent the night there."There are a lot of sleep disorders out there, about 84 of them," says Davidson. "But around 80% of the people we see end up being diagnosed with apnea."St. Marys' state-of-the-art center is regarded as one of the nation's finest. Certainly it is among the most comfortable. Its three private bedrooms could be in any good hotel, and come complete with homey wallpaper, carpeting and double beds with teddy bears resting on plumped-up pillows. Most medical equipment is stashed behind cupboard doors or curtains.On a recent visit, Davidson is busily prepping a sleeper in one such room, attaching sensors to various points on the middle-aged woman's body to measure such factors as leg and eye movement, breathing, muscle tone, oxygen levels in the blood, heart rhythms and brain waves. The sleeper also gets a microphone on her neck to pick up snoring, while a camera on the wall enables a technologist to monitor the patient's every move from the control room.There, information picked up by the sensors scrolls out in wavy lines on paper continuously during the night. Davidson points to an "air flow line" showing hills during inhaling and valleys during exhaling. At one point the line goes flat. "This man stopped breathing for 68 seconds," says Davidson. "It's a clear case of apnea."A sleep study can determine, too, what kind of apnea a patient may have. The most common kind is obstructive sleep apnea, caused by soft tissue in the upper airway and throat--often including such structures as the soft palate, uvula, tonsils and tongue--collapsing during sleep and blocking air flow. Less frequent is central sleep apnea, in which the brain fails to signal the body to breathe during sleep. Finally, there is mixed sleep apnea, a combination of the two.Radtke was diagnosed with obstructive sleep apnea during her first night in the lab. A second night was devoted to setting up her treatment: the wearing of a "continuous positive airway pressure" device, better known as CPAP (pronounced "SEE-pap"). The CPAP blows air into the nose via a hose and mask that fits over the nose during sleep. The air flows in at a carefully calibrated pressure and keeps the soft tissue in the upper airway and throat from collapsing. The whole unit is no bigger than a typical room humidifier, and health insurance usually covers most of the cost.The result? For Radtke, who has been using the device every night since June, it meant no more snoring--and long hours of deep sleep. "I feel much more rested," she says. "It's been a relief to the whole family."Indeed, CPAP is now the most common treatment for sleep apnea, despite its rather unsightly appearance ("It's great birth control!" jokes one woman who dons the mask each night). Surgery involving tightening or removing structures from the throat is costly and often risky, and has been shown to stop snoring but not apnea, according to physician James Sehloff. However, removing tonsils and adenoids is a successful treatment for apnea in children. Dental devices such as "bite blocks" worn at night can help move the jaw forward or otherwise reposition the mouth to free up the airway. Some obese people with apnea may lose the disorder simply by shedding excess weight.For others, a change of sleep position is enough.For most apnea patients, however, CPAP appears to be the best option. Tommy Malkow used to wake up tired after sleeping 10 hours, but attributed his fatigue to the rigors of farm work. He also had high blood pressure and carried some extra pounds. After a night at the St. Marys sleep lab, he was diagnosed with apnea and put on CPAP, which he has been using for more than two years. "It has changed my life," says Malkow."I have more energy, I sleep a whole lot better, and my blood pressure isn't a problem anymore." His newfound energy enabled him to lose weight as well.One night he got caught in a snowstorm and had to sleep away from his CPAP, which he normally uses every night. "Boy, I could really feel it the next day," Malkow says, shaking his head.


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