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Take a Breath
Imagine someone pressing a pillow over your face while you sleep. You wake up and struggle for air. After 10 seconds, you're allowed to breathe again. But pretty soon, the pillow goes back over your face.
That's essentially what's happening if you have obstructive sleep apnea (OSA). Your airway gets blocked, perhaps by your tongue or your throat muscles relaxing too much. You wake up a little as you struggle to breathe again. This could happen hundreds of times a night.
The stress of struggling for air throughout the night is bad for your blood pressure and hard on your heart. You're not getting enough sleep, so you're tired and irritable during the day. You might fall asleep at work or while driving.
But sleep apnea is not a silent disease. So the question to ask yourself is not: "Do I fit the profile?" but rather "Do I have symptoms of sleep apnea?"
Top Signs of Sleep Apnea
You snore. Often and loudly.
If your spouse has moved into the guest room or your landlord says the people in the next apartment are complaining, that's a big red flag.
Someone has seen you stop breathing for a few seconds or gasp while you're asleep.
It doesn't get much clearer than this.
You're sleepy during the day.
Joe Carnevale, a machinist in Philadelphia, didn't realize that his daytime sleepiness was from sleep apnea. "I just chalked it up to the diabetes," he says. High blood glucose levels can make you tired, but Carnevale's blood glucose levels were not that high. His endocrinologist, Arvind Cavale, MD, suspected sleep apnea. Carnevale snores so loudly that his wife wears earplugs. He caused a three-car accident on his way to work one morning when he fell asleep at the wheel and turned into oncoming traffic. Another time he fell asleep at a red light, his foot slipped off the brake, and he tapped the car ahead of him. Carnevale just got the results from his sleep study: severe obstructive sleep apnea.
Other signs that could mean you have sleep apnea:
At Alamo Diabetes Team, a diabetes education service in San Antonio, each patient is asked three questions: "Do you snore? Do you wake up tired? Are you being treated for high blood pressure?" Those who answer yes to any of the three questions are asked more questions to assess their risk. Over half of patients score at high risk for sleep apnea, and their doctors get letters that recommend testing them for sleep apnea. Virginia Zamudio Lange, RN, MSN, CDE, says that screening people with diabetes for sleep apnea should be routine. "It is unacceptable not to screen, given the frequency of sleep apnea and the proven benefits of treatment," says Lange.
Sleep Apnea and Diabetes
Some studies suggest that sleep apnea may worsen insulin resistance. And you can see how sleep apnea may interfere with diabetes treatment. You're dead tired at work, so you keep yourself awake with muffins and coffee. When you get home, all you have the energy to do is sit in front of the television.
Will treating sleep apnea improve blood glucose levels? Researchers in Australia and Minnesota (other research sites may be added in September) are recruiting people with type 2 diabetes and obstructive sleep apnea for the GLYCOSA Study. They will treat half the participants for sleep apnea and see whether they have better blood glucose control than the people who are not treated for OSA.
Whether it helps with blood glucose control or not, treating sleep apnea will improve your quality of life, and it will lower your blood pressure, which lowers your risk of heart attack and stroke.
If you have signs and symptoms of sleep apnea, your doctor may order in-home monitoring. If this shows that you are suffering from sleep apnea, you can move right to treatment.
If in-home monitoring doesn't show that you have sleep apnea, your doctor may order an overnight sleep study, which is more sensitive, more expensive, and may not be available in your town. You'll spend the night at a sleep center, hooked up to sensors that detect how well you're sleeping and whether you're getting enough oxygen. Make sure that you jump through all the insurance hoops before you do the sleep study. Your plan may require that you go to a certain sleep center.
You may want to hear about the experiences of others with this or that device or treatment. You can go to a support group or do an Internet search to find forums on the device you're considering. For example, one entry on www.cpaptalk.com lists the four stages of CPAP adjustment as "intolerable, uncomfortable, tolerable, comfortable." If you know this going in, you'll know not to give up too early.
Getting diagnosed and finding the right treatment takes time. Starting today, you can try some home remedies that may help:
Information in Spanish from the National Heart Lung and Blood Institute
2 comments - Aug 29, 2008
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.