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Wake Up Call for Sleep Apnea Sufferers

Doctors warn sleep condition could lead to heart disease.

As far back as he can remember, Steve Resnic, a 39-year-old Arlington resident, has had difficulty sleeping. It wasn't insomnia or nightmares, nor was it outside influences such as a poor mattress or noise disturbance.

It was the all-too-common disorder of chronic and excessive snoring, and it was taking its toll on his heart, body and general physical well-being. Resnic, like more than half of the people with the disorder, according to National Center for Sleep Disorders Research [NCSDR] statistics, was suffering from an undiagnosed and severely debilitating condition known as "sleep apnea."

"I think 'lethargic' is the best word I can think of to describe it," Resnic, a former attorney turned contractor, said of his daily mindset prior to his diagnosis of the disorder. "It was like when you walk into a room where one light bulb is out, and you don't recognize it's out, but you feel something is wrong."

Although sleep apnea was a condition that Resnic has had since childhood, it was while working as an attorney eight years ago in his home state of Massachusetts that he realized he had a serious health problem and decided to seek medical assistance.

"I was finding it difficult to focus, I was having headaches all the time, napping in the afternoons on a regular basis," he said.

"It's one of those things that kind of sneaks up on you and you forget how it is to not be affected by it," Resnic added. "You get used to it and feeling drowsy all the time and you forget what it feels like to be rested."

SLEEP APNEA IS a serious sleeping disorder first discovered by researchers in the 1960s, according to Edward Grandi, executive director of the American Sleep Apnea Association [ASAA], an advocacy group based in Washington, D.C.

Although several factors can cause the disorder, such as being overweight or excess muscle tissue in the throat, one of the most pronounced immediate effects in all cases is loud, disruptive snoring, according to Dr. Lawrence Stein of Virginia Hospital Center in Arlington.

The condition arises as a result of air passages being consistently blocked by loose or excess muscle tissue throughout the course of a night of sleep, according to Grandi.

These blockages, which are the root cause for snoring, become so great in patients with sleep apnea that airways are actually closed, causing the sufferer's breathing to be blocked for periods of up to two minutes, Stein said.

As oxygen levels in the blood decrease and carbon dioxide levels increase, the body releases a surge of adrenaline to give the patient an added level of energy to increase breathing strength, which results in the continuance of breathing.

Stein, who is the medical director of the sleep lab at Virginia Hospital Center, said that it is these constant interruptions to a breathing pattern that cause the symptoms of sleep apnea. In severe cases of the disorder, patients may have their sleep disturbed up to 100 times an hour, he added.

This lack of consistency in blood pressure and oxygen levels during sleep can cause not just the short-term effects of chronic malaise and headaches, but also a significantly-increased risk for heart disease, adult-onset diabetes and stroke, Stein said.

"Those adrenaline surges cause blood pressure shifts and can ultimately cause trauma to the blood vessels," he said. "When this is happening 60 times an hour, eight hours a night, 365 days a year, this can cause a significant amount of damage."

Sufferers of severe sleep apnea could see their risk factor for heart attacks, diabetes and stroke increase from 1.2 to 2 times the normal rate on average, Stein said.

AS MANY AS 18 million Americans could be living with sleep apnea and not even know it, according to NCSDR data.

"We're talking about a public health crisis of mammoth proportions," Grandi said, explaining that the disorder is left largely untreated due to a lack of perception of the condition.

"The big problem with sleep apnea is that it manifests itself when you're in bed and asleep," he said. "People wake up and they think that they've had a crummy nights sleep, they blame it on the mattress or just an uncomfortable sleeping style."

Yet those suffering from the occasional bout of light snoring shouldn't necessarily run out to a sleep disorder specialist, Stein said.

"The things that people look for ... are things like daytime sleepiness; the tendency to sleep during the day; loud disruptive snoring; disheveled bedding; excessive night sweats and constantly finding yourself waking up in the middle of the night," he said.

"When it's real bad, disruptive snoring, a bed partner might realize this disruption," Stein added. "If they're interrupted enough on a regular basis, they might want to talk about sleep apnea with their partner."

AT THE TIME of the initial discovery of the negative effects of the condition, the only way of treating the serious cases of the sleep apnea was by conducting a tracheotomy on the patient, according to Grandi.

It wasn't until 1981 that less severe methods for treatment were established.

"In those people with mild to moderate sleep apnea ... we encourage them to exercise more in order to lose weight, sleep on their side ... and eliminate excess alcohol consumption," all moderately variable elements that can eliminate blockages, Stein said.

"There is also an oral appliance that looks like a mouth guard made by dentists and orthodontists that can move the jaw itself forward so that [the patient] can always breathe in at night," he said. "But there's a limit to how far you can push the jaw without it being uncomfortable."

For sufferers of more severe sleep apnea, like Resnic, more options are available.

The option that Resnic chose to utilize after being diagnosed with sleep apnea eight years ago was to utilize a Continuous Positive Airway Pressure device.

The "C-PAP" device is used while sleeping to continually allow oxygen to flow through the nasal cavities, making sure that the airways are not blocked and that the patient's sleep is not interrupted by blockages.

Although surgery for sleep apnea is available, Stein notes that they may not fully eliminate sleep apnea in patients and have "significant complications."

"Results [of surgery] are variable in the elimination of sleep apnea because it may be caused in multiple sites in the throat," Stein said. "It's very hard to find the site of obstruction."

Also, local sleep apnea support groups exist for sufferers of the disorder.

Roland Finkel, a McLean-based retiree, who is the founder and organizer of the only support group registered with the ASAA in Fairfax County, said that the support groups are useful for people to confront the personal, professional and practical challenges that arise from the disorder.

"There are a lot of human relations issues, especially inside of a family system" that arise from suffering from sleep apnea, Finkel said. The support group "helps people deal with a wide range of things that could come up in relationships with people with sleep apnea."

Finkel, whose monthly group averaged about 12 people present at each meeting, has not had a meeting in "about a year," due to personal health problems, but said that the ASAA is working with him to restart the meetings shortly.

FOR RESNIC, the treatments available which have eliminated the discomfort and drowsiness he suffered over years of undiagnosed sleep apnea have been life-changing.

"If you develop [sleep apnea] and are not sleeping, it can have a lot of effects," said Resnic, sitting on a pile of bricks outside of the home he is renovating. "It can make you depressed, it can make you overweight because you're eating more, sleeping more ... and you don't have the energy to exercise."

"I wouldn't even want to think about life without [being treated for sleep apnea]," he added. "To have your dreams come back to you and to feel rested and awake, I couldn't think about it."

"I think the way to see treatment benefits is that in the short-term, you get a better night's sleep, your partner gets a better night's sleep, and you feel more refreshed in the morning," Stein said. "In the long term, you avoid increased risks for severe health conditions down the line."

"It's the difference between life and death," said Grandi. "You can't underestimate your quality of life when it comes to these issues."