Now I lay me down to sleep apnea

Most certainly our incredible bodies can - and do - silently harbor diabetes, hypertension and some other major disease insults for several years but still continues to provide us with acceptable function.

Sooner or later, however, some astute medical intruder is going to pick any of these offenders off and we will be hustled into treatment.

Not so for those of us burdened by obstructive sleep apnea. This somnolent and destructive night hawk may actually shackle us for up to a decade - or even longer - without being diagnosed. And, even then, that diagnosis is most likely to be finally established when a terminally-provoked bedmate, tired of sleepless and arrestive rib-jabbing nights, demands a physician encounter for the offending bedmate.

That induced medical confrontation usually ends for the snorer with a night spent hitched to a machine-studded bed in a sleep laboratory at room-rates approaching a suite in the Ritz.

It is in this environment, however, that, with the help of an attached and recording polysomnogram device, true obstructive sleep apnea is definitely diagnosed and therapy begun.

This sleep apnea is a disorder characterized by repeated and unwanted breathless moments (apnea) of at least ten seconds duration while we sleep - a time interval which is equivalent to missing one whole breathing episode. Continuing attempts to breath, spurred on by declining oxygen levels in the blood and brain, eventually succeed, and we start up again.

Although there happen to be a few other unrelated causes for this apneic lapse, the vast majority are due to the obstructive relaxation of the muscular and other soft tissues leading from the mouth, nose and throat, to the lungs. Such tissue relaxation allows the collapsing breath channels to vibrate together - and, thus, snoring.

Not all snoring is apneic-related, and not all apnea results in audible snoring because not enough snoring air may always get through, but most often these events do accompany one another, and a most telling sign is when a snore suddenly stops right in its middle!

The absolute diagnosis of true obst ructive sleep apnea depends upon polysomnogram evidence of five or more such obstructive episodes per hour of sleep.

Of compatible interest here, sleep, still a minimally understood body function, is clinically divided into various stages. One very studied area is the REM (Rapid Eye Movement ) stage which, in adults generally lasts 1 or 2 hours and may occur several times in one night.

REM is an exceedingly important time of brain stabilization, reconditioning and memory reinforcement. It is also a time when most dreaming occurs and when all muscle tone is almost totally attenuated. These valuable REM sleep and brain reparative times are especially interrupted and foreclosed by sleep apnea which further, during other of our sleep stages, may induce hypertension, interfere with immunity responses and destroy or at least diminish the fundamental restorative power inherent in a normal, sustained sleep.

Importantly, separate studies show that people who suffer from bad apneic nights are seven times more likely to be involved in an automobile accident!

Well, then, who amongst us is that one in five at real risk for this breathless night-time journey? Excluding children with bad tonsil/adenoid affairs, and younger adults with very severe upper respiratory and bronchial infections, the true sleep apnea assault is confined to middle aged men and to women of that same somewhat certain age - and to both as they move on up.

It is more commonly found in overweight or swarthy individuals, and amongst those of us with belated evening feasting and drinking habits. As indicated earlier, the final diagnosis of sleep apnea lies with a device which rests in the sleep lab., and which continuously measures our breathing and certain other responses, as we sleep- the polysomnograph.

Dealing with true obstructive sleep apnea is a difficult task. Of personal value, weight loss, avoidance of late eating and drinking, never smoking, arranging the bed linens so that sleeping on one side with a modest upper bed elevation is the only alternative, (sleeping back-flat is an apnea enhancer), the avoidance of powerful sedatives - all these commitments help and are very worthwhile.

Medications and/or surgery, purported to help somewhat are available, but appear to be of uncertain value and most definitely carry their own risks and problems that must be understood and evaluated by the proposed sleep apnea recipient.

The much preferred treatment involves institution of continuous positive air pressure (CPAP) delivered to the apneic each night of sleep, from a bedside air compression device, through tubing and a face mask.

This device overcomes the breathing channel's resistance and apnea is safely blown away. Many of the encumbrances encountered in early lugubrious CPAP devices have been overcome, so that today's recipient doesn't feel like a cosmonaut or a warrior as they hitch up to the new small units at bedtime.

The treatment of sleep apnea just very recently got a boost as Medicare has tentatively agreed to cover home-rented polysomnograph testing and its results. The agreement goes into effect in March, following a period of public comment.

The significant savings and convenience of this measure is enormous and will hopefully spur earlier and more frequent sleep apnea diagnosis and subsequent care.

Clark Gillespie, M.D. is a Professor Emeritus at the University of Arkansas.

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