Friday, May 2, 2008

Big Pun, Pimp C and You - Real Talk About Sleep Apnea

“Damn, homie! Get up! Roll over or do something! I can’t sleep with you making all that noise. Sounds like you about to suffocate or die or something.” These were actually my words, (minus a few explicative comments) to my roommate and the leading scorer on our basketball team during my freshman year in junior college.

Dude snored so bad that my coach finally put him in his own room, after moving him twice, so my other teammates could get some rest.

Everybody thought it was funny, unless you had to share a room with him.

It was great once he got his own dorm room; we could sleep and he could sleep in peace - or could he?

None of us knew that we were witnessing a potentially life threatening problem. A problem that often goes unrecognized because it’s happening while the victim thinks he is resting. This silent killer is called sleep apnea.

It is estimated that there are 18 million people in the United States (US) who are living with diagnosed cases of sleep apnea with many more undiagnosed. We all are familiar with National Football League legend and hall of fame honoree Reggie White, Chad “Pimp C” Butler, and Christopher “Big Pun” Rios. Each suffered from this often missed and under-treated disease. All of them died way too young.

Maybe if Pimp C knew more about the deadly combination of mixing his breath-slowing cough syrup with this disorder, he would still be alive. Maybe if Big Pun understood the relationship between sleep apnea, being overweight, and how they all relate to high blood pressure, heart disease, diabetes, and strokes he would be alive. And maybe, just maybe, if the NFL did not require linemen to average over 300 pounds or be financially penalized, traded or fired for being “underweight,” Reggie White would still be around…

Sleep apnea, in its simplest definition, means that a person’s breathing is interrupted while he is attempting to get some z’s. Some individuals will not breathe for 20 to 30 seconds before “coming up” for air. The family and significant others describe the sleep of these individuals with terms like, “loud snoring, restlessness, gasping for air, and sounds of choking”. Most patients complain of daytime fatigue and falling to sleep or dozing off while at work or driving.

The short term problems are obvious, and range from being kicked out of bed by your lady, losing your job or killing yourself or another driver. The questions I’m often asked are, “How does sleep apnea happen” and “Is it treatable?”

There are two types of sleep apnea: Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA). Obstructive Sleep Apnea is the most common form, and is caused by a blockage of the airways. This usually occurs when the tissues of the neck and throat collapse during sleep. In CSA, there is no airway blockage, but the brain fails to signal the muscles to breathe during sleep.

There can also be a mixed picture where both Central and Obstructive Sleep Apnea exist together. Risk factors for sleep apnea include:
male gender
being overweight
being over the age of 40
having enlarged tonsils
having a large neck size (greater than 17” in men and 16” in women)
having a family history of sleep apnea

When a person with sleep apnea stops breathing, the body has a reflex that will wake them up. The patient does this all through the night and rises the next morning feeling tired and sleepy. During these periods of apnea (which means not breathing) the body is deprived of oxygen to the brain and tissues.

The response is an increase in red blood cells, that carry oxygen, and over time the blood gets thick and sluggish. If blood flow to the brain or heart is not adequate, a heart attack or stroke can result.

To diagnosis sleep apnea, my patients are referred to an ear, nose and throat (ENT) specialist and sent for a sleep study or polysonogram (PSG). The ENT specialist will evaluate the patients for correctable causes of sleep apnea. If the soft tissue in the throat is too thick, the septum in the nose is deviated, or other facial abnormalities exist, these can be surgically corrected.

The sleep study is designed to detect other causes of sleep disorders, like restless legs syndrome, and to guide sleep specialist in treatment regimens for the disease. A PSG involves going to a lab and sleeping. Sounds easy, but with electrodes over your body and someone analyzing your sleep, it may be a little uncomfortable.

Once the diagnosis is made, conservative treatment options include weight loss, avoiding sedatives like codeine, alcohol, and sleeping pills, smoking cessation (smoke increases airway swelling), and avoiding sleeping on your back.

One of the most common forms of treatment includes wearing a mask at night that will keep the airways open. This treatment is called Continuous Positive Airway Pressure (CPAP). The mask covers the nose and mouth while you sleep, and is connected to a machine that delivers a continuous flow of air, maintaining an open airway. Special dental devices can be designed to keep the airway open as well as the surgical procedures mentioned earlier.

There is even a medication called Provigil that some physicians use to treat the daytime fatigue and tiredness, but this is usually in combination with CPAP and good sleep hygiene. Many people are resistant to using their CPAP machine, and although cumbersome, it could very well save your life.

If you have any of the signs and symptoms above, see your physician right away, improve your sleep, and get back in bed with the one you love.

And by the way, my former roommate wears his CPAP and is doing well…

For more information on sleep apnea visit read about Pimp C at (c) 2008 Rani Whitfield. Published April 29, 2008 at

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