Don’t ignore these not-so-obvious signs of sleep apnea

With a diagnosis of sleep apnea, a patient is usually prescribed a continuous positive airway pressure (CPAP) machine. (Dream time / TNS)

Leslie Orr began to experience a combination of symptoms several years ago that affected his quality of life.

She regularly had migraines. Diabetic, she could not control her A1C blood sugar levels, even with medication and watching her diet.

Leslie Orr, who works as a respiratory therapist, was surprised to learn that she suffered from sleep apnea. (Leslie Orr)

Despite a full night’s sleep, she was also tired – all the time. The kind of fatigue that drove her to take naps most of the time. Only, she never really felt less sleepy. And no matter how much caffeine she consumed, she never felt energized.

She had worked with her primary care provider on her health issues. Desperate, she was ready to try Botox as a migraine remedy.

A friend who worried about his midday naps suggested that Orr get tested for sleep apnea. Orr was surprised.

It is estimated that 4% of American men and 2% of women suffer from sleep apnea. People with sleep apnea stop breathing several times a night when their upper airways collapse while they sleep. Because sleep is frequently interrupted, people with obstructive sleep apnea never achieve a state of deep, restful sleep.

As a respiratory therapist, Orr knew that excessive daytime sleepiness was a symptom of sleep apnea. But she had convinced herself that her fatigue and drowsiness was due to the fact that she was working as a mother of six children.

“I neglected myself and assumed it was because I was so busy,” Orr said.

Not to mention that she didn’t fit the typical person with sleep apnea: an obese middle-aged man who snores loudly. Orr was in her early forties, and on the rare occasions she snored, she did so quietly.

She had other symptoms that she hadn’t thought of. The National Institutes of Health notes that women are more likely to report headaches, depression, anxiety, insomnia, and trouble sleeping. Children can have problems with bedwetting, hyperactivity and learning.

Orr was already familiar with the complications of sleep apnea, including high blood pressure, stroke, heart failure, and heart attack. Her grandmother, a loud snorer, had died of a sudden heart attack, and Orr suspected she had undiagnosed sleep apnea. Orr decided it was worth talking to his doctor about getting tested for sleep apnea.

Her doctor ordered a home sleep study and, of course, Orr was diagnosed with obstructive sleep apnea. Hers was a mild case with fewer incidents in which she stopped breathing overnight. However, her doctor feared that Orr’s blood oxygen level would drop severely until she was 70 during sleep.

Her doctor prescribed a continuous positive airway pressure device called a CPAP. It is a machine that uses pressurized air to keep a person’s airways open while they sleep.

“I am very grateful to have had this machine,” Orr said.

Adapting to a CPAP

Treatment for sleep apnea ranges from specially designed mouthpieces or surgery to remove tissue, tonsils, adenoids, or uvula, according to the Eastern Iowa Sleep in Cedar Rapids ( But the most common treatment is a CPAP machine.

A CPAP involves a small machine with tubes attached to some type of mask. Some patients even refuse to try a CPAP. They don’t want to take a machine with them to travel or can’t sleep with something on their face.

“It’s just something we’re not used to doing,” Orr said.

Others, like Orr, find over time a combination of machine and mask that works best for them. Because she regularly outfitted patients with CPAPs and masks, she knew where to start. The first machine she tried was too loud for Orr, who is a very light sleeper. She now uses a much quieter machine.

Sleep apnea terminology

Polysomnogram: A study of nocturnal sleep. The options are a laboratory sleep study or a home sleep apnea test.

Obstructive sleep apnea (OSA): A sleep disorder in which breathing stops during sleep. These breathing interruptions can range from five to over 100 times per hour for people with untreated sleep apnea.

Continuous positive airway pressure (CPAP): This machine is the most common treatment for sleep apnea. CPAP uses a mask and a hose to blow pressurized air into the airways to keep them open during sleep. Specially designed mouthpieces or surgery to remove tissue, tonsils, adenoids, or uvula are also options for treating sleep apnea.

Two-level positive airway pressure (BiPap): Delivers positive pressure flow with inspiratory (inspiration) and expiratory (expiration) pressures.

Sources: Eastern Iowa Sleep Center, Iowa Physicians’ Clinic, University of Iowa Hospital and Clinic Sleep Disorders Center

Find the right mask

The most common complaints among CPAP users involve wearing a mask. Patients have the opportunity to try different masks until they find one that is more comfortable and suitable for the way they sleep.

Orr suggests calling your insurer or asking your provider to check how often you are allowed to try on a new mask. Usually there is a 30 day trial period. By taking advantage of this, patients can learn what type of mask they like, Orr said.

When patients receive their first CPAP, a respiratory therapist like Orr will help them put it on. The therapist will ask him questions about sleeping positions, nasal passages, and if he tends to breathe through his mouth. The respiratory therapist will choose a mask based on these responses, then adapt it to the patient.

There are three main types of masks:

  • A full face mask that covers the nose and mouth
  • A nasal mask that only covers the nose
  • A nasal pillow mask that is inserted into the nostrils.

A hose can be connected near the mouth or at the top of the head; the headgear keeps everything in place.

Full face masks for people who tend to breathe through their mouths, have a deviated septum or have nasal problems. A nasal mask would make them feel like they couldn’t breathe. A person who easily feels claustrophobic, watches TV in bed, or moves around a lot at night may start with a nasal mask or nasal mask.

The respiratory therapist works with the mask until the patient feels they are in the correct position. Then the mask is connected to the CPAP through the hose and the machine is turned on.

Facial structure, wearing dentures, and facial hair can affect the fit of a mask. “Even sensitive skin can be a problem,” Orr said.

A common fit issue is wearing a mask that is too tight, which can prevent the mask or pad from inflating properly. Orr uses the two-finger method to test the space between the patient’s skin and the equipment.

Another fit issue is wearing a full face mask under the chin when it should be over the chin. Orr said a respiratory therapist can teach you how to adjust and tighten a mask when your machine is on.

Finding an appropriate mask and machine helps patients comply until they realize the benefits of using a CPAP. She started out by using her CPAP for four hours a night and now for up to seven or eight hours on average.

Most CPAPs have an app or SD card that allows providers and patients to track their sleep patterns. A provider can explain any changes in this pattern and make suggestions for improving sleep.

Life with a CPAP

Around the same time Orr was diagnosed with sleep apnea, her husband was diagnosed with it as well. Now they are both sleeping better.

Orr’s doctor was shocked at the changes she went through. She has lost weight, her lab results are better, and her overall health has improved.

“I have more energy. My migraines are gone,” Leslie said.

Overall, she feels more rested and doesn’t need the dose of caffeine she previously relied on. More surprisingly, her A1C is under control and she is no longer taking diabetes medication.

“I didn’t have a lot of strength to do a workout, but now I have it,” Leslie said.

Her family have noticed that she is more energetic.

“I garden now and do more with my little girls,” Leslie said.

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