Sleep apnoea How it can strike you in midlife
Author Rachel Abbott tells Peter Stanford how the onset of snoring was a sign of severe midlife sleep apnoea
Rachel Abbott swears she didn’t snore until she reached her 50s. “Perhaps a little bit, but suddenly it was getting much worse,” recalls the businesswoman and bestselling crime writer. “My three stepchildren thought it was hysterical the amount of noise I started making at night. It was so deafening that my husband, John, couldn’t get to sleep and so I often ended up in the spare room.”
Abbott had always known she had a problem with breathing when asleep. “My mum used to say she had to prod me when I was a baby because I would stop breathing,” recalls the 65-year-old, “but then she also told me the doctors had told her my teeth would go green and fall out, and that hadn’t happened.”
She gives me a quick flash of a perfect all-white smile to prove it. We are meeting in a slightly hushed, fancy central London hotel. Though Abbott seems perfectly at home, the backdrop jars slightly with the downto-earth, plain-speaking charm of this Mancunian – though, in recent years, she has relocated to Alderney in the Channel Islands. “I love Manchester,” she explains, “and go back there as often as I can, but I just can’t stand the weather. I needed a bit more warmth and a bit less rain.”
It wasn’t only the snoring, though, that was on Abbott’s mind. She suspected she could have sleep apnoea, which can cause snoring.
It is a condition where, in its commonest form – obstructive sleep apnoea, or OSA – the throat muscles intermittently relax and block the airway when we sleep, interrupting breathing. Though it is more common in men – who account for twice as many cases as women – and can increase the risk of high blood pressure, strokes and heart attacks if not treated, the condition often goes undiagnosed.
The Sleep Apnoea Trust estimates that there may be up to 3.9million sufferers in the UK, while recently released data from NHS Digital shows a steep rise in primary admissions for sleep apnoea from 5,675 in 2012-13 to 7,557 in 2016-17. That increase has been attributed to higher levels of obesity, especially in the young, with the extra body weight pressing down on the airwaves when we lie down.
“My husband had been telling me I would stop breathing while I was asleep,” Abbott says. “He said he was lying there waiting to see if I would breathe again. And there had been a couple of occasions when I had a cold and had woken up in the middle of the night, unable to get a breath, because my throat felt as if it had collapsed.”
The first two doctors she asked about sleep apnoea waved aside her concerns. “Their reaction was, ‘Oh, you don’t want to bother with that. Everyone’s got a bit of it’.” Abbott took them at their word and got on with life.
And she had plenty on her plate: first, starting up and running a successful software company, which she sold in the early 2000s for a seven-figure sum; then moving to Italy in 2005 with John, her second husband, to renovate a 15th-century Italian monastery they had bought; and more recently, as that rarest of literary beasts, a bestselling, self-published author whose name isn’t E L James.
Abbott’s seven “domestic noir” page-turners, starting in 2011 with
Only the Innocent, and featuring her enigmatic detective, Tom Douglas, have now sold more than three million copies worldwide, attracting interest from TV producers in the UK and France.
It was two and a half years ago, when she checked into a smart health clinic in Austria to try to lose weight, that someone first took her sleep apnoea seriously. At their insistence, she asked her GP on Alderney to refer her to a specialist sleep clinic. The result was a nasty shock. “They told me that it is not unusual for people to stop breathing briefly when they are sleeping for up to five times an hour. Anything more than that is sleep apnoea. If the number goes over 30, then you have severe sleep apnoea. I had been recorded in their tests as stopping 73 times an hour, sometimes for over a minute at a time.” She is laughing as she tells me, but the diagnosis must have alarmed her. “Well, the specialist did say to me, ‘Basically, you haven’t slept for 10 years. I don’t understand how you are standing up and walking around’.” Part of the shock was that she had never really been aware of her disturbed sleep patterns. “What happens,” she says, “even though I didn’t know this at the time, is that you stop breathing while you are asleep and then your brain says, ‘Hang on, something is not right here’. So it wakes you up for a fraction of a second, just long enough for you to take a breath, and then go back to sleep. You’re never awake long enough to remember it.”
Once diagnosed, though, the cure was simple, if challenging. She wears a breathing mask in bed at night that blows air at high pressure via two tubes into her nostrils, splinting open the airway.
“There are all sorts of different ones, from full-face things to one with a blue cloth that you put over your nose and makes you look like an elephant with a trunk. What I use now is called a Wisp, and sits neatly under the bottom of my nose.”
Getting an uninterrupted night’s sleep has been, she says, “a complete revelation”. But isn’t wearing a mask uncomfortable? “I remember one of the doctors saying to me, ‘You don’t want to wear a mask in bed at night. What’s your husband going to think?’ That may well be what puts so many people off going to their doctor with sleep apnoea.”
But not her? “You don’t have to put the mask on until the lights go out,” she replies pragmatically. “You could even lie there until your partner has gone to sleep to put it on. It’s not the end of the world, is it?”
When she began writing, Abbott says, she did her plotting at night, while awake in bed. “I always used to have a notepad next to me, and I’d be regularly sitting up to write things down. Now that never happens.”
A case of exhaustion leading to creativity? Other writers have reported that they can only produce their best work when at full tilt, on the edge of collapse. “Well, now you mention it, my PA swears that now I am sleeping more, I am much more scatterbrained than before. I used to be so focused. I don’t think my exhausted brain could compute any more than one thing at a time. Now I am much more scattered.”
So might her fans detect the impact of her sleeping properly for the first time in a decade in the pages of her books? “I’m not the best judge of that,” she laughs. “I just have to do it all during waking hours, and that takes me a bit more time.”
Come a Little Closer by Rachel Abbott is published in e-book and paperback by Black Dot. For more details of National Stop Snoring Week (April 23-27), go to britishsnoring.co.uk
‘You haven’t slept for 10 years. I don’t understand how you are standing up’