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

Leslie Orr began experiencing a combination of symptoms several years ago that affected her quality of life.

She regularly had migraines. A diabetic, she couldn't get her A1C blood sugar level under control even with medication and watching her diet.

Despite getting a full night's sleep, she was also tired — all the time. The kind of tiredness that caused her to rely on naps most days. Only she never really felt any less sleepy. And no matter how much caffeine she consumed, she never felt energized.

She'd been working with her primary care provider on her health issues. Desperate, she was ready to try Botox as a migraine remedy.

A friend who was concerned about her midday naps suggested Orr be tested for sleep apnea. Orr was surprised.

An estimated 4 percent of American men and 2 percent of women have sleep apnea. People with sleep apnea stop breathing multiple times each night when their upper airway collapses as they sleep. Because sleep is interrupted frequently, people with obstructive sleep apnea never reach a state of deep, restorative sleep.

As a respiratory therapist, Orr knew that excessive daytime sleepiness was a symptom of sleep apnea. But she'd convinced herself that her fatigue and sleepiness were because she was a working mom of six kids.

"I was overlooking myself and assumed it was because I was very busy," Orr said.

Not to mention that she didn't fit the typical person with sleep apnea: a middle-aged, obese man who snores loudly. Orr was in her early 40s, and on the rare occasions that she snored, she did so softly.

She had other symptoms that she hadn't considered. The National Institutes of Health notes that women are more likely to report headaches, depression, anxiety, insomnia and sleep disruption. Children may experience bed-wetting, hyperactivity and learning issues.

Orr already knew of 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 her doctor about getting tested for sleep apnea.

Her doctor ordered an at-home sleep study, and, sure enough, Orr was diagnosed with obstructive sleep apnea. Hers was a mild case with fewer incidents during which she stopped breathing during the night. However, her doctor was concerned that Orr's blood oxygen level dropped severely to the upper 70s during sleep.

Her doctor prescribed a continuous positive airway pressure machine called a CPAP for short. It's a machine that uses pressurized air to keep a person's airway open while they sleep.

"I'm very thankful I got that machine," Orr said.

Adjusting 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 (eisleep.com). 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 refuse to even try a CPAP. They don't want to pack a machine for travel or can't sleep with anything on their face.

"It's just something we're not used to doing," Orr said.

Others, like Orr, discover over time a machine and mask combination that works best for them. Because she regularly fitted patients with CPAPs and masks, she had a good idea 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.

Finding the right mask

The most common complaints among CPAP users involve having to wear a mask. Patients have the option to try different masks until they find one that's more comfortable and suitable to the way they sleep.

Orr suggests calling your insurance carrier or having your provider check with them for how often you are allowed to try a new mask. Usually, there's a 30-day trial period. By taking advantage of that, patients can learn which type of mask they like, Orr said.

When patients receive their first CPAP, a respiratory therapist like Orr will help them get it set up. The therapist will ask them about sleeping positions, issues with nasal passages, and whether they tend to breathe through their mouth. The respiratory therapist will choose a mask based on those answers, then fit it to the patient.

There are three basic types of masks:

A hose may be connected near the mouth or at the top of the head; headgear keeps it all in place.

Full-face masks for people who tend to breathe through their mouth, have a deviated septum or have nasal issues. A nasal mask would make them feel like they can't breathe. Someone who easily feels claustrophobic, watches TV in bed or moves around a lot at night might start with a nasal mask or nasal pillow mask.

The respiratory therapist works with the mask until the patient feels like it's in the correct position. Then the mask is connected to the CPAP via the hose and the machine is turned on.

Facial structure, wearing dentures and facial hair can affect how well a mask fits. "Even sensitive skin can be an issue," Orr said.

A common fit issue is wearing a mask too tight which can prevent the mask or cushion from adequately inflating. Orr uses the two-finger method to test how much room is between the patient's skin and the gear.

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

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

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

Life with a CPAP

About the same time Orr was diagnosed with sleep apnea, her husband was also diagnosed with it. Now they're both getting better sleep.

Orr's doctor has been shocked by the changes she's experienced. She's 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 refreshed and doesn't need the caffeine boost that she used to rely on. More surprisingly, her A1C is under control, and she's off medication for diabetes.

"I didn't have a lot of strength to do a workout, but now I do," Leslie said.

Her family has noticed that she's more energetic.

"I'm gardening now and doing more with my little girls," Leslie said.