Waking up to the need for sleep
Sleep apnea, related disorders left untreated can have staggering implications
At 17, Zoe Nagerl makes a surprising poster child for sleep apnea — a disorder usually associated with “overweight old people,” in her words.
But that is what sleep researcher Dr. Elliott Lee diagnosed after Nagerl visited the sleep lab where he works at the Royal Ottawa Hospital more than a year ago. The diagnosis was surprising in many ways. Nagerl doesn’t snore — which is often a sign of sleep apnea. she is young, healthy and not overweight. Perhaps more surprising was the effect the diagnosis had on the teenager.
Nagerl had been treated for depression, severe mood swings and anxiety for several years before her visit to the sleep lab. As soon as she began receiving treatment for the sleep disorder — by wearing a device known as a “continuous positive airway pressure machine” or CPAP, at night — her symptoms improved dramatically. Her mood was better, she was more alert and better able to attend school.
“When you are well rested and have more energy, you have a better outlook,” she said.
Lee will use Nagerl’s case as an example in a talk Friday at the ROH’s Women in Mind conference to make a point: Sleep apnea and related disorders are more common than people think — in women and men of all ages — and, left untreated, they can have staggering health implications.
“People expect patients (with sleep apnea) to be overweight, fat, older men ... when they look at her they think she shouldn’t have that problem,” he said.
Importantly, he said, her case illustrates that sleep and psychiatric illnesses can have a “bi-directional” relationship. “People know that psychiatric illnesses can cause sleep problems, but they don’t recognize that sleep problems can contribute to psychiatric difficulties.”
The effects of poor sleep are all around us — from sports arenas and intensive care units to fertility clinics. Yet, even as research increasingly links poor sleep to poor mental and physical health, sleep disorders including sleep apnea remain widely misunderstood and undertreated, says Lee.
Women are particularly likely to be undiagnosed, Lee says, because breathing-related sleep disorders look different in women than in men.
To further complicate diagnosis, most research on sleep disordered breathing — which includes sleep apnea and upper airway resistance syndrome — has been done on men.
Men suffering from the syndrome usually snore, feel sleepy during the day and have difficulty focusing. Women might not snore and will complain of fatigue, irritability and sometimes depression, more general symptoms less likely to be associated with a sleep problem.
Although breathing- related sleep disorders are hugely underdiagnosed (some have speculated that up to 90 per cent of them are not diagnosed), Lee says they are much less likely to be diagnosed in women than men.
And, as research on the negative health effects of poor sleep mount, Lee says there are real reasons for women and men to be concerned about untreated sleep disorders.
Breathing-related sleep disorders have been linked to higher risk of hypertension, cardiovascular disease, depression and anxiety, among other things.
One study published in the British journal the Lancet concluded that patients with untreated sleep apnea are twice as likely to have a fatal heart attack as other men and three times as likely to have a nonfatal heart attack. The study, however, only looked at men.
Lee is involved in research with the Ottawa Fertility Centre looking at whether sleep disordered breathing contributes to women having problems getting pregnant or contributes to miscarriages.
There have also been links between sleep disordered breathing and pregnancy problems, including hypertension, pre-eclampsia and gestational diabetes.
Lee said there has been more focus on sleep-disordered breathing in recent years since the advent of CPAP and other treatment, but there is still a long way to go.
Lee said he would like to see screening done — which usually just involves asking questions about sleep — on all pregnant women.