This is the first of a nine-part print and online series looking at the science of sleep and the vital role of sleep in maintaining overall health.
Life had become such a struggle for Kerri Schabert that she admits being diagnosed with obstructive sleep apnea was a blessing in disguise.
"I was anxious for the results and relieved to find I had severe sleep apnea," she says of her diagnosis earlier this year.
Sleep apnea, which affects more than one million Canadians, is a sleep disorder in which breathing repeatedly stops and starts during the course of the night. Left untreated, sleep apnea not only disrupts sleep and waking life, but increases the risk of heart attack or stroke up to three times.
"It's fundamentally a problem with the brain," says Brian Murray, an associate professor of neurology and sleep medicine at the University of Toronto. The disorder can take one of three forms: the most common is obstructive sleep apnea, in which a physical block in the airway prevents breathing; central sleep apnea, where the brain stops sending the signal to breathe; or a mixture of the two.
As Dr. Murray explains, sleep apnea causes fragmented sleep, which can lead to drowsiness, exhaustion and a lack of concentration during the day, and it deprives the brain of oxygen, which can contribute to cognitive impairment and long-term damage.
"This is a significant public health problem," he says, adding that while only 3 per cent of Canadians have been diagnosed with sleep apnea, the real number is probably five times that.
As a 35-year-old woman, Ms. Schabert didn't meet most of the typical criteria that lead doctors to make a positive diagnosis. Typical risk factors, such as a being over 40 and male, didn't apply, and as a single person, she didn't know if she was a snorer, one of the common symptoms of sleep apnea (although about half of adults snore and it is not a definitive sign of sleep apnea).
However, she certainly displayed the kind of daily fatigue that is so often associated with the sleep disorder, exacerbated by working long hours in her job as a human resources adviser in Sherwood Park, Alta. "I lived for the weekends just to get enough naps to keep me going through the next week at work," she says.
Her family doctor sent her to a psychiatrist, who put her on antidepressants, but Ms. Schabert also downloaded a sleep app on her phone. She scored just 17 out of 100 and the results were enough to persuade her doctor to refer her to a sleep specialist.
Atul Khullar, the medical director for the Northern Alberta Sleep Clinic and the senior national consultant physician for a national network of sleep clinics, MedSleep, admitted Ms. Schabert for an overnight sleep study, where a patient is hooked up to electronic monitoring machines and observed throughout the night.
Her results were startling, indicating that she had an average of 31.3 apneas an hour during the study. She was then fitted for a continuous positive airway pressure (CPAP) machine, which delivers a constant flow of air to the patient throughout their sleep, keeping the airway open and allowing unobstructed breathing.
The CPAP machine is generally regarded as a first-line treatment for sleep apnea, and is very effective when worn; however, roughly 20 to 30 per cent of users have trouble tolerating the device while sleeping. Other treatments include a dental appliance to bring the jaw forward, and nasal valves, which are both more suitable for milder apneas, and surgery, such as removing tonsils. However, the rates of success with these other treatments is far less than 100 per cent.
"There is nothing as proven as the CPAP machine," says Arthur Vanek, a physician who works in the divisions of respirology, critical care and internal medicine at St. Joseph's Health Centre in Toronto.
Though Ms. Schabert says her first night using the CPAP machine was rough because of the unusual feel of the face mask, the results left her in no doubt of the machine's benefits.
"I couldn't believe it the next day – this is how normal people feel?" she says. "I was so encouraged. [I thought] this is going to be life changing, and it has been."
The diagnosis and treatment has given Ms. Schabert the energy to change career paths, and she now sells new homes around Alberta. She also has the time and energy to invest in herself, and she has dropped 10 pounds through a healthier program of diet and exercise, though Dr. Khullar acknowledges the sleep apnea may have played around with her metabolism.
Carrying excess weight is another major risk factor for developing sleep apnea, and as obesity rates increase, so will the rate of sleep apnea among the population. Ms. Schabert has been told by Dr. Khullar that she may not need to use her CPAP machine if she loses more weight. But given how good she feels with it, she is not about to give that up and takes it with her on the road for business trips.
"The only drawback is my friends say, 'You must look like Darth Vader,'" she says. "Other than that, I love it. I'm just a little upset that it took 35 years to get treatment for this."
Signs of sleep apnea, according to physician Atul Khullar:
- Heavy snoring
- Feeling tired and fatigued daily
- Waking up frequently with a jolt during the night
- Going to the bathroom frequently
A body mass index over 30; older than 40; male (men are likelier to develop sleep apnea); depression (30-40 per cent of sufferers are likely have sleep apnea).