One night in the winter of 2006, Scott Fine and his wife, Susan, were at a cocktail party when one of their doctor friends turned to Scott and said, “You look terrible!” When Scott told the friend he woke up shaking about 15 times each night, turned ashen gray after walking up a flight of steps and was gaining weight rapidly, she said, “It sounds like you have sleep apnea.”
Fine, who owns a real estate appraisal business in Hunt Valley, disregarded his friend’s counsel. For a few more months he continued to ignore his poor sleep, weight gain, low energy and irritability, all of which had been part of his life to an increasing extent for 30 years. Then he was forced to take notice. “I woke up one morning, looked in the mirror and noticed my right eye and the right side of my mouth were drooping,” he says. “Looking back, I think I had experienced a small stroke.”
Eventually Fine consulted with his physician, who seconded his friend’s cocktail party diagnosis, telling Fine he believed he had obstructive sleep apnea (OSA). The Greek word apnea means “without breath” and OSA, the most common form of the condition, occurs when the muscles surrounding the upper airway relax, causing it to collapse and preventing the passage of air, and reducing the amount of oxygen delivered to body tissues and organs. Sufferers of OSA may stop breathing hundreds of times each night, with each lapse lasting as long as a minute or more.
On his doctor’s recommendation, Fine underwent a sleep study at Greater Baltimore Medical Center. The study revealed that on a scale of 0 to 20 (0 being normal and 20 the most severe), Fine’s OSA score was 18. In healthy individuals, blood oxygen levels usually range from 95 to 99 percent; during the night he’d spent at GBMC, the level of oxygen in Fine’s blood had dropped to 60 percent. And he had awoken 121 times— just during the first hour. Fine’s symptoms were so extreme, in fact, that doctors at GBMC stopped his test and placed him on oxygen and a CPAP (continuous positive airway pressure) machine right then and there. The next day, the hospital sent an oxygen tank, oxygen generator and a CPAP machine to his home. “They were afraid I would die any minute,” says Fine.
The CPAP is the size of a 1970s-era clock radio and it sits on a bedside table. A long tube connects it with a mask Fine places over his nose. When the switch is flipped, the CPAP pushes air into his nostrils and the air pressure keeps his airway open during sleep, preventing apnea. Within days of initiating CPAP use, Fine felt “alive and full of energy”— radically different, in other words. He believes that had he not started treatment for OSA, he would probably not be alive today. “Nowadays I feel like I’m 16 again,” he says, blue eyes twinkling mischievously, “In fact, Susan told me to go find a girlfriend!”
I heard Scott’s story about six months ago when my husband, Robert, and I visited the Fines’ home, and I was intrigued. Robert’s chronic, ear-splitting snoring had been a major source of conflict throughout our 15-year marriage, and I had often voiced concern that he might be suffering from a sleep disorder. In fact, while I love him dearly, had I not purchased a white noise machine with the comforting sounds of the ocean, rain forest, birds and thunder, we might not have remained married— and I might have succumbed to my unspeakably evil impulse to smother him with a pillow. In addition, Robert was constantly tired, frequently awoke with headaches and was often irritable and tense. “You should go for a sleep study,” I told him.
At first, Robert was skeptical. But after hearing from several more friends who’d undergone treatment for OSA, he saw his physician and obtained a referral to the sleep clinic at Sinai Hospital. His sleep study revealed that he did indeed suffer from OSA— he was awakening 27 times per hour because of it. Robert’s oxygen level was 82 percent, nowhere near as low as Fine’s, but considerably below normal levels. Several days later, a CPAP machine arrived at our house.
At first Robert had some trouble getting used to it— and with a large hose protruding from the batman-like mask upon his face, it took me some time, too. However, the results immediately seemed worth the spectacle. While Robert wasn’t claiming to feel 16, he did report feeling well rested and more productive at work— and he was definitely less irritable at home. When we told others about Robert’s diagnosis, almost all swore that they or their spouse must suffer from OSA, and many told us about someone they knew who was using the CPAP with great results.
Nancy Gore, a sleep patient at University of Maryland Medical Center, is one such CPAP convert. In fact, Gore, 46, and her husband, William, 44, of Pasadena are both on the CPAP. Gore says it has not only helped her to feel well rested but since beginning treatment, her high blood pressure has improved and she needs less medication to control it. Once Gore’s husband began CPAP treatment, she noticed a great improvement in his mood and energy level. “Before he was on it, I used to feel embarrassed wearing the mask,” she says. “Now that we’re both wearing them we just joke about it.”
OSA treatment seemed like a silver bullet for so many people, it sounded almost too good to be true. So I went to talk with Dr. Abdallah Kafrouni, an internist with sub-specialties in critical care, pulmonology and sleep medicine who works at Northwest Hospital’s new sleep disorders center. Kafrouni gave me a tour of the new unit, which is complete with single rooms— furnished in blond wood and painted in restful blue and green hues— and adjoining baths, large televisions and sleep number beds.
While Northwest’s sleep center treats patients with a range of disorders including narcolepsy, insomnia, sleepwalking and restless leg syndrome, by far the most common diagnosis is OSA. Kafrouni explained that although the disorder can affect anyone, the likeliest candidates are people who snore, middle-aged and older adults, men and those suffering from obesity, high blood pressure and heart disease. He believes the fact that more people are receiving treatment for sleep disorders is due to greater awareness— and also to the fact that so many Americans are now overweight. The good news is that, as Kafrouni says, “OSA is highly treatable. Success rate for treatment at the sleep center is about 95 to 99 percent. Here, everyone gets better, and it changes lives.”
For years, I’ve complained of my constant sleepiness, morning stiffness and crankiness. And, although I try to blame my children, it’s really my fault they’re late for school almost every day— I just can’t wake up early enough. So when the Northwest sleep center team invited me to experience a sleep study for myself, I took them up on it. I didn’t truly expect them to find anything wrong, but I was curious. In particular, I wondered if the discomfort I felt when sitting for long intervals might be caused by restless leg syndrome, something diagnosable by a sleep study. So, 10 days later, I return to the hospital, this time as a patient.
Two sleep technicians dressed in hospital scrubs meet me in the emergency room and escort me to the bedroom where I’ll spend the night. Once there, tech Wendy Whitmire has me sit in a chair and begins the process of applying approximately 20 small electrodes with pastel-colored wires to my scalp, face, chest and legs.
The electrodes will monitor my brainwaves, eye movements, muscle tone and snoring. Sensors placed by my nose and mouth will measure airflow. Belts on my chest and abdomen will monitor movements associated with breathing, and an EKG sensor on my chest will measure my heart rate. A sensor attached to my finger will measure the level of oxygen in my blood. When Whitmire is finished, I catch sight of myself in a mirror and discover I resemble an extraterrestrial alien who has been in a serious accident. I back gingerly into bed, taking great care not to upset any of the wires and sensors.
My husband has long compared me to the princess in “The Princess and the Pea.” Needless to say, I am dubious that I will get a good night’s sleep. While I am permitted to sleep on my side, the wires underneath my head, connected to my legs and to one of my fingers make movement very difficult, and finding a comfortable position is nearly impossible. Within no time, I am a nervous wreck. Why had I chosen to do this? How will I get through the next six hours?
At approximately 5:20 a.m., I hear Whitmire’s voice wishing me good morning through the intercom. I feel exhausted. Every part of my brain and body aches. When I arrive home, I climb into bed next to Robert, or “Sleep Apnea Boy,” as I’ve begun to call him. He’s hooked up to his CPAP, sleeping comfortably.
One week after my study, I receive a call from Kafrouni, who tells me there are “a few mild events that showed up in the study.” During my night at Northwest, he says, I failed to enter the REM (rapid eye movement) phase of sleep. Although my sleep time was less than optimal, during the times when I was asleep, Kafrouni saw episodes of OSA-Hypopnea Syndrome, which is characterized by slowed breathing that can interrupt sleep. Though Kafrouni assures me the syndrome isn’t dangerous, he recommends a follow-up appointment.
On the one hand, the idea that there might be a medical reason for my rather normal symptoms seems highly improbable to me. On the other hand, I am thrilled by the prospect that these problems might be resolved as easily as Robert’s. I see myself running marathons, my lineless, well-rested face glowing with pride and health. I imagine the extra productivity I will achieve once I am well rested. Perhaps I can work an extra job, I think, make more money and advance my career. With my children, I will have the patience of a saint. I will no longer be the brunt of jokes by night-owl friends who know they can’t call me after 8:30 p.m.
During my appointment, Kafrouni looks in my throat, and tells me I have Class 4 Mallampati, which could indicate an increased incidence of sleep apnea. Apparently Mallampati is the name of the scientist who discovered that some people have larger than average soft palates, or tonsils, that can block their airways while they sleep. Kafrouni recommends I try the CPAP. I picture Robert and I sleeping in our king-size bed with a CPAP between us, two tubes connecting us, like one of those old walkmen radios with two sets of headphones. However, Dr. Kafrouni explains that if the CPAP proves beneficial to me, I will have my own machine.
When I leave the doctor’s office, I immediately call Robert. “Sleep Apnea Boy, this is Sleep Apnea Girl,” I say. I can’t help but feel that my diagnosis has strengthened our bond— here is something new, something wholly unexpected, that we now share.
- Sinai Sleep Center 410-601-9523, lifebridgehealth.org
- Sleep Disorders Center at Northwest Hospital 410-521-2200, lifebridgehealth.org
- Greater Baltimore Medical Center Sleep Center 443-849-3874, gbmc.org/sleepcenter
- The University of Maryland Sleep Disorders Center 410-706-4771, umm.edu/sleep
- Johns Hopkins Hospital Sleep Disorders Center 443-287-3313, hopkinsneuro.org/sleep
- Sleep Center at Franklin Square Hospital 443-777-8382, franklinsquare.org
- St. Joseph Medical Center Sleep Disorders Center 410-337-1240, sjmcmd.org