(The following story by Mary Beth Faller appeared on The Arizona Republic website on March 29.)
PHOENIX, Ariz. — When Will Banning got home from work in the early evening, he wanted to go straight to bed.
“I was very tired all the time,” says Banning, 38, of Anthem. “I would go to bed at 7 or 7:30.
“I wouldn’t want to get out of bed in the morning, and I was constantly tired.”
Worst of all, his wife would have to sleep in another room because of his snoring.
Banning had the classic symptoms of obstructive sleep apnea: daytime sleepiness, crankiness and loud snoring.
“There was a time in my life when there was some depression,” he says, “and I attribute that to sleep apnea.”
Eight years ago, Banning was diagnosed with the condition. He is one of 5 percent of the U.S. population afflicted with sleep apnea, the second-most-common sleep disorder after insomnia. This week is National Sleep Awareness Week, and Thursday is Sleep Apnea Awareness Day, intended to draw attention to a condition that can be dangerous. Besides the dangers of excessive sleepiness, people with untreated sleep apnea are at higher risk of heart attack, stroke, accidents and high blood pressure.
Lack of sleep in general also has been linked to obesity and depression. A recent study published in the Archives of Internal Medicine found that an extra 20 minutes of sleep per night seemed to be associated with a lower body mass index, although the study didn’t focus on obstructive sleep apnea specifically and no cause and effect was determined.
A 2003 Stanford University study found that people who reported that they had sleep apnea were five times more likely to report being depressed, although it’s unclear how the conditions are linked.
A number of treatment options are available for the condition, but the most common have problems. The CPAP (continuous positive air pressure) machine is so uncomfortable that up to 15 percent of people who need it won’t use it. Surgery can be extremely painful and is not always effective. But a new type of surgery offers hope for people with mild to moderate sleep apnea. It’s less painful and can be done in the office.
Sleep apnea occurs when the soft tissue at the rear of the throat collapses during sleep, closing the airway and stopping breathing. The sleeper then wakes briefly in order to start breathing again, and sleep is constantly interrupted.
People whose breathing stops five to 15 times per hour have sleep apnea that is considered mild, 15 to 30 episodes is moderate, and anything over 30 episodes is severe. The episodes can last for as long as 40 seconds.
“We used to think it was all older men, but now we know it’s an equal gender affliction,” says Robert G. Hooper, medical director of the Scottsdale Sleep Center and an expert on the condition.
Sleep apnea also occurs in all age groups, although many times, children grow out of it.
Many people with sleep apnea finally seek treatment because their bed partner can’t stand the snoring, Hooper says.
The best treatment for sleep apnea is the CPAP. About the size of a shoebox, the device pumps air into a patient’s nose and throat via a mask, opening the passageway during sleep. Sleep experts say the CPAP is very effective in patients who use it faithfully.
But patients sometimes must try many different masks to find one that fits correctly, and the pressure of the machine has to be just right. For some, the air has to be humidified, or the patient must use nasal sprays.
Some people can become claustrophobic with the mask, says Janet Tatman, clinical director of the Sleep Disorders Center at John C. Lincoln Hospital in Phoenix. The center uses a behavioral treatment called systematic desensitization to teach clients effective relaxation techniques. These can help patients get comfortable in as little as three or four appointments.
Another treatment option is an oral appliance. Worn at night, the appliance brings the jaw forward to open the throat. Tatman says this treatment can be effective, and many dentists will fit a patient with the device.
But Banning never adjusted to his CPAP machine. It was uncomfortable and noisy, he said. He didn’t try the oral appliance, opting instead for surgery.
“Almost all my patients who have had a sleep study ask about surgery, and I push them for a CPAP because I can’t guarantee even close to 100 percent success for surgery,” says Robert Bridge, an ear, nose and throat doctor in Phoenix.
There are several types of surgery. A tracheostomy, in which a hole is cut in the throat, is reserved for the most extreme cases. More commonly, surgery involves trimming and tightening excess tissue at the back of the throat. The procedure can be done with a laser. But even surgeons say it is not always effective. The success rate ranges from about 30 to 60 percent, according to the National Sleep Foundation, and a major drawback is extreme pain.
“I’m very upfront with my patients about it; it’s very painful,” Bridge says. There are many nerve endings in the throat, and they take up to 10 days to heal. At the same time, the wound is exposed to air, saliva and food.
Sometimes, while surgery itself doesn’t always cure the sleep apnea, it can make the CPAP more comfortable and effective.
Bridge is one of the few doctors in the Valley performing a new kind of surgery, for people with mild to moderate sleep apnea, in which three small, woven implants are inserted into the upper palate to reduce vibrations. The surgery, called the Pillar Procedure, can be done in the doctor’s office under local anesthesia. It also can help people who snore loudly but don’t have sleep apnea.
Bridge, who has performed about 50 implants in the past year, says there was significant reduction in apnea episodes in about 80 percent of his patients.
Implant surgery involves much less pain, he says. However, the procedure is not yet covered by insurance and costs about $1,400 to $2,200.
George Dudley, 77, a retired business owner who lives in Scottsdale, underwent the implant surgery in December to treat his loud snoring.
“I played golf the day after the surgery,” he says. “I didn’t miss a meal.”
Dudley, who is divorced, estimates that his snoring is about 80 to 85 percent reduced. “I would do it again.”
Banning underwent the implants in addition to more extensive surgery, which included removing his tonsils.
He compared the pain to “a hot knife on your throat forever” – which was a few weeks in his case. He also experienced a rare bleeding complication that landed him back in the hospital for a few days.
However, Banning says, the surgery changed his life. “Now, everybody notices that I’m a different person,” he says.
For starters, he is more alert and has more energy.
“The pain (from surgery) was horrible,” he says, “and I tell myself I would have done something different. But the reality was that it was the only choice.
“The other night I stayed up until 10:30 watching a movie with my wife.”
And now, when it’s time for bed, the two retire to the same room.