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Sleep Apnea Booming; New Treatments Offer Alternatives

Original Article

By Karen Weintraub, Special for USA Today

Sleep apnea affects an estimated 5% to 10% of Americans and is undiagnosed in most of them. It can also lead to obesity, diabetes, high blood pressure, strokes and heart attacks.

For 30 years, Bob Bleck of Mentor, Ohio, snored nearly every night and napped nearly every day.

Finally, his wife got fed up and made him see a doctor. He was diagnosed with obstructive sleep apnea, a condition in which people stop breathing for short periods, disrupting their sleep, sometimes hundreds of times a night.

Sleep apnea used to be seen as a mere annoyance, but in the past decade or two, it has become clear that it can be life-threatening — both to the person with the condition and others on the road. Sleep apnea doubles the risk of traffic accidents; truckers with untreated, moderate to severe forms of the condition are barred from driving in some states.

Sleep apnea — which affects an estimated 5% to 10% of Americans and is undiagnosed in most of them — can also lead to obesity, diabetes, high blood pressure, strokes and heart attacks.

“Untreated severe apnea can take 10 to 15 years off someone’s life,” says Joseph Golish, a sleep medicine expert for more than 40 years and a professor at the MetroHealth System in Cleveland.

Sleep apnea is generally caused by a crowded upper airway, muscle weakness around the throat, or weight gain that adds fat around the airway, leading to collapse during sleep.

Waking up activates the body’s fight-or-flight response, causing heart rate, blood pressure and hormone secretions to climb, says Lawrence Epstein, a sleep medicine expert at Harvard Medical School and Boston’s Brigham and Women’s Hospital. Repeated activation and lack of downtime stresses the heart.

Until very recently, the only treatments with any real track record were throat surgery and a sleep machine with a face mask that many compared to Darth Vader’s.

Bleck tried the system, known as a continuous positive airway pressure (or CPAP) machine, for about two months. But he says he couldn’t stand it.

It was noisy, it made him claustrophobic, and the hose that the mask connects to bothered him every time he tried to move. “I could not get over it,” he says.

The CPAP has been the standard of care for sleep apnea for three decades, and it helps nearly all the people who faithfully use it — though Bleck’s reaction is quite common.

“As many as 80% of patients who say they use their CPAP don’t use it enough to keep them safe,” says Golish, Bleck’s doctor. Medicare and some private insurers have stopped paying for CPAP beyond three months if data indicate the patient isn’t using it.

Luckily, there are several other treatments, including three new ones:

• Provent Sleep Apnea Therapy, made by Theravent Inc. in San Jose, is like tiny Band-Aids that fit over each nostril, with a valve in the middle that helps create pressure in the airway so it remains open. A one-month supply costs about $70. This is the treatment Bleck now uses.

• The Winx Sleep Therapy System by ApniCure Inc. of Redwood City, Calif., is a small mouthpiece that rests inside the sleeper’s mouth, creating suction to open the throat. Winx costs around $700 for the machine, Golish says, similar to CPAP.

• Inspire Medical Systems, based in Minneapolis, is awaiting approval from the U.S. Food and Drug Administration for its Inspire Upper Airway Stimulation, which uses a pacemaker-like device to stimulate a branch of the hypoglossal nerve controlling the tongue muscles.

An alternative on the low-tech end for people with mild to moderate apnea, adjustable dental appliances help keep the lower jaw up and forward, opening the airway.

And of course, the lowest-tech treatment of all is weight loss, which can help in cases where obesity is a factor, says Meir Kryger, a sleep expert, pulmonologist and professor of medicine at the Yale University School of Medicine.

In general, apnea is vastly undertreated, Kryger and others say. Doctors often fail to ask questions that would lead to the diagnosis, or they don’t realize that symptoms such as heart disease, diabetes and obesity might all be related to underlying sleep apnea, Epstein says.

Research hasn’t yet proven that treatment can reverse health consequences, says Molly Cooke, president of the American College of Physicians. The college released a paper in September recommending weight loss and CPAP use as first-line therapies to treat apnea.

“It’s clear that having sleep apnea is associated with a whole variety of bad outcomes,” Cooke says. “What is not clear is that treating the sleep apnea decreases or eliminates many of those bad outcomes.”

For Bleck, getting his apnea treated has been life-changing. Not needing naps every afternoon means he’s been much more productive at the small information-technology firm he owns.

“It’s been kind of amazing,” he says. He has more energy, is more flexible, and isn’t as cranky as he used to be, he adds. “It changes everything.”

Signs of sleep apnea:

• Your bed partner notices that you snore and/or gasp for air regularly during sleep. (Not everyone who snores has apnea, but nearly everyone with apnea snores, and snorers are more at risk for developing apnea if they gain weight.)

• You’re not rested by sleep and/or need frequent naps.

• You have hard-to-treat high blood pressure.

• You are obese, often with a large belly. (Having a neck collar size bigger than 16 inches for women and 17 inches for men.)

• The signs can be different in children, who tend to get hyperactive or have learning problems when tired, so they are often misdiagnosed.