When apnea disrupts your sleep cycle, the results can be disastrous. Research has suggested the risk might be greater for people with spinal-cord injury.
Stress from work, finances, relationships, and other things in daily life have caused most of us to occasionally lose a few winks of sleep. However, when that tossing and turning in bed is caused by a health problem, the issue becomes far more serious.
Normal sleep occurs in stages and cycles. In non-REM (Rapid Eye Movement) stages, you drift from the more alert sleep stages (Transition and Light) to the restorative, or restful, stage (Deep Sleep). REM is the active dream stage of deep sleep. Non-REM and REM stages form a 90-minute sleep cycle that repeats over the course of a night.
Obstructive sleep apnea (OSA) occurs when the soft tissue in the back of the throat collapses during sleep and prevents normal breathing. Without proper airflow, there is a drop in your blood oxygen level and a rise in the blood carbon dioxide level. The brain detects these changes and wakes you to “jump-start” breathing and restore normal blood levels.
This disruption in the normal sleep cycle also repeats throughout the night. Most people wake and fall back asleep without knowing anything happens, so it is important to know OSA’s risk factors and symptoms.
Anyone can have OSA, but the risk is greater for people who:
- Are male
- Are overweight or obese (usually with a neck larger than 18 inches)
I was unaware I napped many times, falling asleep during conversations and a few times when driving my power wheelchair.
- Sleep on their side and/or back
Common symptoms include:
- Falling asleep in 1–2 minutes instead of the normal 10–15
- Loud snoring
– Restless sleep (sometimes choking or gasping for air)
- Waking up with a sore and/or dry throat
- Waking with a headache
Take My Own Advice
I have worked for the University of Alabama–Birmingham (UAB) Spinal Cord Injury Model System for more than 13 years. I produce educational materials for people with spinal-cord injury (SCI) and professionals. I also have a C5-level SCI following a car accident in 1984, so I often produce materials on secondary conditions of SCI that directly affect me as well as others.
I have known for years I have OSA. In fact, I wrote an article on the condition in 2005 for our newsletter, “Pushin’ On.” In that article, “Obstructive Sleep Apnea: a Nightmare of a Problem,” I explained OSA and how it can be a serious health concern if untreated. I noted that research has also suggested the risk for OSA might be greater for many people with SCI when compared to the general population. I encouraged everyone to see a doctor if they suspect they have OSA.
Although I usually follow the advice I offer in the materials I produce, I did not do so with OSA. I used every imaginable excuse to avoid treatment despite having the risk factors and experiencing symptoms.
Like a Blink
While I was making excuses, however, my symptoms became progressively worse. Over the years I went from enjoying a normal life to the threshold of death without even realizing it.
I eventually reached the point when I “slept” 4–5 hours at best on a typical night. I felt increasingly more fatigued, low on energy, and sleepy during the day. I experienced 10–20-second “micro” naps during the day that were like a blink to me. I was unaware I napped many times, falling asleep during conversations and a few times when driving my power wheelchair.
I sought treatment when I finally admitted I lost touch with what it is to have a “normal” life. I was not enjoying my life. My work production seriously declined. I was tired of always being tired.
Although staying overnight in a clinic was not ideal, I worked out the problem issues to do the sleep study needed to diagnose OSA.
Lucky To Be Alive
“I don’t mean to scare you, Mr. Klebine, but you are lucky to be alive.” These were the doctor’s first words when she gave me the shocking test results.
Two factors sum up the outcome. First, consider that mild OSA is a stop in breathing lasting at least 10 seconds and occurring 5–15 times per hour of sleep. A moderate condition is 15–30 stops per hour. Severe OSA is 30 or more stops per hour. I averaged more than 200 stoppages in an hour! I was unknowingly waking with each stoppage and not reaching deep sleep.
Second, normal blood oxygen level is at least 95%. A drop to 80–85% is a serious condition. The heart can suddenly stop due to a lack of oxygen if there is a drop below 80%. My oxygen level repeatedly dropped below 80% while I stopped breathing and never fully recovered to a normal level each time my brain tried to jump-start my breathing.
A continuous positive airway pressure (CPAP) delivers a continuous level of air pressure and is the most common treatment option for OSA, but I now use a bilevel positive airway pressure (BiPAP) for treatment. It delivers higher air pressure for breathing in and lowers air pressure for breathing out. The BiPAP is better for me because I have impaired respiratory muscle function due to my injury.
The airflow delivery is through a mask that fits over the nose and/or mouth. I tried different masks during the sleep study to find the most comfortable one for me. It took a little time to adjust to wearing it, but it is not as bad as I imagined. I once had problems with nighttime sinus drainage, but there are no such issues when wearing the mask.
I was concerned about power outages, but the BiPAP has an alarm if there is an outage and vents for breathing normally if airflow stops. I also had concerns about being unable to move the mask due to my physical limitations, but I can make slight adjustments to it if needed.
A New World
I’m now living in what seems like a new world. I am awake. I have more energy. My mind is fresh, alert, and focused. I have reconnected with a more enjoyable, productive, normal life.
Frankly, I am embarrassed I ignored the advice I offered others and failed to seek treatment for my OSA. I am lucky to be alive. I hope sharing my experiences can serve as a “wake-up call” for those who suspect they may have OSA.
Please follow my advice and get treatment—now!