Women are more likely to have their sleep apnea undiagnosed than men. (Photo: Stocksy/Ina Peters)
“Do you think I could have sleep apnea?” I kept asking my doctors. Fatigue hit me five years ago; I could sleep a long time for nights in a row and still wake up feeling wiped out. But my doctors either offered me sleeping pills, or asked if I was depressed. After all, I don’t fit the stereotypical picture of a sleep apnea patient — an obese man — or have the classic symptoms — a rattling snore, or propensity to nod off in public.
For those of you who are unaware: Sleep apnea is a disorder where your breathing pauses or becomes shallow, pushing you out of deep sleep into the lighter kind. This can happen if the brain doesn’t send correct signals to the breathing muscles or, more commonly, if the airway collapses or is blocked.
Some 13 percent of Americans may be living with undiagnosed sleep apnea, many of them women. Studies suggest that twice as many men have the condition, but “women are still more likely not to be diagnosed,” Grace Pien, a sleep specialist at Johns Hopkins Bayview Medical Center in Baltimore, Maryland, tells me. Sleep disturbances are often more subtle in women, with symptoms that could have many causes. The problem often arrives around menopause, for example, misleading doctors. Up to 30 percent of people with sleep apnea aren’t overweight and 10 to 20 percent don’t snore, Pien notes. Signs can include fatigue, morning headaches, low mood, or insomnia.
The “gold standard” treatment for sleep apnea is a continuous positive airway pressure (CPAP) machine and a mask that pumps a flow of air into your nasal passages to keep the airway open. I’d never seen one until I met my boyfriend, who told me how much his CPAP machine had helped him. So I asked a doctor at a clinic whether he’d refer me to a sleep study to monitor my breathing and evaluate me for sleep apnea. He looked me over and said, “You’re not that heavy. You don’t have an especially fat throat. Some people just aren’t good in the morning.” (Then he told me a story about his girlfriend being grumpy at breakfast.)
But I was curious and my boyfriend agreed to let me borrow his machine for a night. I awoke drunk on guzzled air, as if I’d been on deck on a racing sailboat. I said, “I’m getting one.” My guy was shocked: “A lot of people hate them,” he said.
I went back to the clinic and saw another doctor who was impressed that I actually liked the machine. Maybe that’s because 40 to 70 percent of people who own a CPAP are “non-compliant” — skipping nights, taking it off during the night, or stopping altogether. That’s a shame, because untreated sleep apnea increases the risk of diabetes, stroke, high blood pressure, heart failure, and car accidents from sleepiness at the wheel. Your body will feel the effects of oxygen deprivation even while you’re awake, some research suggests, and more so if you’re female.
I had to know: Did I have sleep apnea? It would take a sleep study to find out. After at least five confusing calls to make sure my insurance would cover it, I had my appointment: A car would pick me up at 8:15 p.m. and I’d spend the night in a sleep center in the Bronx. Along with my purse, I brought a bag with pajamas, a toothbrush, a sleeping pill (just in case), a magazine, and my iPod. I was told I’d be home by 6:30 a.m. the next day, so I wouldn’t need a change of clothes.
The car arrived and dropped me off on a dark, silent street in front of a brightly lit medical office. I rang the buzzer, and a few minutes later, a woman appeared. She told me she’d be monitoring me during the night. She took me to my home away from home for the night — a room that looked like an ordinary exam room, except for the full-sized bed with a white bedspread facing a flat-screen TV. By the standards of American hotel rooms, this one was tiny, but I’d slept in tighter spaces in Nairobi and Rome.
Settling in was easy — I took one trip in my socks to the bathroom to brush my teeth. By 10 p.m., my technician had returned and began wiring me up. She placed sticky patches with sensors called electrodes on my scalp, face, chest, arms, legs, and a finger. She explained that during my sleep, the sensors would record my brain activity, eye movements, heart rate and rhythm, blood pressure, and the amount of oxygen in my blood. The sensors led to thin flexible wires that would transmit the data to a computer in the next room, where she’d be up all night. I asked her if she liked working at night; she shrugged.
She also placed elastic belts around my chest and belly to measure chest movements and breathing. That made me wonder how I’d get to a bathroom during the night, but my technician promised that she’d come to unhook me if I sat up. I read for about a half-hour before I put my magazine down and turned off the light. I heard another patient’s buzz-saw snore through the walls, and was worried I wouldn’t be able to fall asleep — but before I knew it, I opened my eyes and it was morning.
“Do you think I have sleep apnea?” I asked the technician. “You’ll have to get the results from the doctor,” she said, “but you snore.” That was news to me.
Related: 7 Ways to Stop Your Snoring
A week or so later, I met with the doctor who evaluated my report. She told me that my sleep was interrupted 10 times an hour. In severe sleep apnea cases, people may stop breathing 100 times an hour. Five to 15 interruptions an hour is considered a mild problem, but still significant. I learned later that a recent study with 239 participants, divided between those with no sleep apnea and mild cases, concluded that mild sleep apnea may actually be normal.
My doctor didn’t mention that study, but she did recommend that I lose some weight and get a CPAP machine. I ended up spending another night at the sleep center to see how well I was able to snooze while wearing the mask.
A technician delivered my CPAP machine to my house and showed me how to use it, which wasn’t all that complicated. Unlike many people, I was able to sleep with it immediately. There was just one problem — the air can dry out your nose and throat, and I had nosebleeds for weeks. I went back to the center for a follow-up visit, where a physician’s assistant advised me to squirt my nose with saline and then apply sesame oil before bed. She also coached me on how to use a feature in the machine that heats up water to make the air moister.
Related: 5 Sleep Problems Nobody Talks About
The first clear benefit of treating my sleep apnea was a surprise: My memory became richer. After two weeks on the CPAP, memories began bubbling up, as if I’d run into old friends and family I didn’t usually see. Some people notice a burst of vivid dreams, a phenomenon called “REM rebound,” when your body catches up on the REM dreaming sleep that was previously interrupted.
People tell me I look better, happier, more rested. There’s even research to back that up: Volunteers were shown photos of 20 patients before and after at least two months of regularly sleeping with a CPAP machine. They were twice as likely to say the patients in the post-CPAP photos were “more alert, more youthful, more attractive, and more likely to reflect treatment.”
So for several months now, I’ve slept every night with a machine. While I may not leap out of bed in the morning, I’m better rested. I have the energy to go biking most mornings, which I couldn’t have managed before.
I’ve been thinking about my mother, who died some years ago. She used to fall asleep in the early evening on the sofa with her mouth open, a classic sign of sleep apnea; we kids would poke her awake. I feel guilty about that now, and lucky to live in a time when a woman is more likely to get help.
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