Wednesday, December 7, 2016

Exhausted? Maybe You Have Sleep Apnea

By Mary Ellen Bianco


Linda Williams (left) and Missi Quiggins didn't realize their health issues were attributed to sleep apnea. 



Missi Quiggins and Linda Williams both have obstructive sleep apnea (OSA), a potentially serious disorder in which breathing repeatedly stops and starts during sleep. Their quality of life has greatly improved since they started treatment. Although they work at a medical office that specializes in pulmonary and sleep disorders, the cause and diagnosis of the apnea surprised them.


Missi, age 44, is the patient care coordinator at Chest Medicine Associates and Sleep Medicine Clinic. The Louisville native had been chronically tired since she was a teenager. “I was always busy as a mother and wife and I muddled through the day,” Missi says. “I wanted to exercise after work, but I had a hard time mustering up the energy to do so. I couldn’t wait to get into bed.”

Photos by Patti Hartog

It wouldn’t take long for Missi to fall asleep, but she would awaken every four to five hours with her mind racing about things she needed to do. “I was in bed for eight or nine hours, but it wasn’t good quality sleep,” she says. “It was very erratic.”

In 2015, Missi was advised to do a home sleep study because of her daytime fatigue. She used a device called a pulse oximeter, which is placed on a finger to indirectly monitor the oxygen saturation of blood and the pulse; and a nasal cannula, a lightweight tube that splits into two prongs which are placed in the nostrils. It delivers supplemental oxygen or increased airflow to a patient. She also wore a strap around her waist to measure her breaths.

“My respiratory disturbance index was 7.2,” Missi says. “Over 5 is considered abnormal.” According to webmd.com, the apnea-hypopnea index (AHI) reflects how many times the patient stops breathing for 10 seconds or longer during an hour of sleep. It reflects the severity of sleep apnea with 0-5 normal; 5-15 mild; 15-30 moderate; and 30 or more severe.

Missi also had heart palpitations. “An echocardiogram (EKG) didn’t indicate a problem with my heart,” she says. “My diagnosis was OSA.” This happens when the muscles and tissues in the throat and air passage relax while the person is sleeping. The tissues block the flow of air into the lungs

Missi started wearing a constant positive airway pressure (CPAP) mask. Her husband was already using one. “I used to work for one of the companies that provided the CPAP and I swore that I would never wear it,” she says. But Missi doesn’t struggle to get out of bed anymore, and her daytime sleepiness is reduced. When time permits she squeezes in time for exercising. “Getting a good night’s sleep can literally make you feel like a different person,” she says. “I’m not a physician, but I would recommend a sleep study to rule out apnea — it’s a good place to start.”

Missi and Linda wore The Dreamwear Nasal Mask and say they could sleep comfortably when wearing it. 
Linda, age 59, has lived in Louisville for 11 years. The mother of two adult daughters is a receptionist at Chest Medicine Associates and Sleep Medicine Clinic. She regularly exercised, but three years ago she started gasping for breath when she walked uphill. “I could tell that something was different,” she says. “I had shortness of breath while exercising, and my feet would swell.”

In 2014, Linda’s blood pressure started increasing. “During an annual exam, an echocardiogram (EKG) indicated that I was throwing extra heartbeats,” she says. “My doctor suggested that I see a cardiologist.” Linda wore a holter monitor for 24 hours. The monitor is a small battery-operated portable device that measures and records the activity of the heart through electrodes attached to the chest.

“The test confirmed that at night the extra heartbeats increased,” she says. Following that, Linda did a sleep study, although her co-workers didn’t think she could have sleep apnea. She’s tall, thin, and doesn’t have a thick neck, which is one of the risk factors. “My AHI rating was 13,” she says. “The apnea causes my heart to pump more. I wasn’t getting the sound sleep that I thought I was. I don’t think there are real parameters based on your body type,” she says. “You can have sleep apnea without daytime sleepiness or night disturbances, at least in my case anyway.”

Linda started treatment with an oral appliance which fits like a retainer, supporting the jaw in a forward position to keep the upper airway open. She realized that it wasn’t working adequately, so she’s been using a CPAP mask since August. “When I was diagnosed I didn’t think that I could wear the mask,” she says. “I’ve had no trouble adapting to it, and it doesn’t bother my husband.”

Linda takes a low-dose blood pressure pill and a separate low-dose water pill. She has hypothyroidism and would attribute the heart palpitations to her thyroid or caffeine intake. “I notice the biggest difference in my exercising,” Linda says. “I no longer have heart palpitations. Anybody who thinks they have sleep apnea should get tested and be treated for it.”






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