Obstructive sleep apnea is a potentially life threatening condition that affects an estimated 18 million people in the U.S., but many of those who have it ignore it – until they face a crisis – like having an accident related to exhaustion.
“It’s very dangerous, but very treatable,” says Beth Rodgers, a UWM professor of nursing who studies sleep apnea, particularly the obstacles that keep people from getting effective treatment.
Obstructive sleep apnea is a condition that causes episodes of stopped breathing and jerking awake during sleep as throat muscles relax and block the airway, explains Rodgers. The interrupted sleep often results in daytime sleepiness and general ongoing exhaustion. Sometimes – in as many as 20 percent of cases – people are unaware they have a problem – until they fall asleep at the wheel of their car or suffer another potentially life-threatening wake-up call.
In our busy, stressed society, “being really, really tired has become an expectation for some people” says Rodgers. “People may think the symptoms they’re experiencing are normal.”
In addition to the danger of automobile accidents, untreated sleep apnea is linked to such serious conditions as stroke, heart failure, hypertension, metabolic syndrome, depression and gastrointestinal disturbances, says Rodgers. While obstructive sleep apnea can be treated, many patients don’t follow recommendations and may face these serious complications.
“A lot of people say, ‘I didn’t know this could kill me,’” says Rodgers. Rodgers’ research is focused on finding out from patients themselves why they don’t follow treatment recommendations, what barriers prevent them from seeking treatment and what strategies they use to manage the condition. She’s talking to both patients who’ve sought treatment and those who haven’t.
Often, she says, people may be aware they have a problem, but have a “tremendous resistance” to getting it diagnosed. “Some people may go as many as 20 years knowing they have a problem, but they don’t seek treatment until they have a crisis event like an auto accident. When people do get treated, the results are often life-changing. They say, ‘I’ve got my life back.’”
As a scientist in the College of Nursing Self Management Science Center, Rodgers is part of a group of UWM nurse researchers who are exploring, developing and testing ways to help people with chronic problems like sleep apnea better manage their own care. The ultimate goal is to improve quality of life as well as control extra health care costs that result when such conditions are not well managed and patients end up in the emergency room or hospitalized.
An estimated 18 million people in the U.S. suffer from some form of sleep apnea, says Rodgers, ranging mild to severe. While the stereotype is that the condition affects older, overweight men, in some cases there is a hereditary component and the condition can occur among women and young, active people. “One patient I met was 21 years old and very thin,” says Rodgers.
While weight loss, oral appliances and surgery may help in some cases, more severe cases require the use of a CPAP (continuous positive airway pressure) machine. The CPAP is a device that the patient wears while sleeping that uses continuous air pressure to keep airways open – a sort of “splint” that prevents the collapse of weak airway muscles.
However, Rodgers is finding in her research interviews that many who suffer from sleep apnea are reluctant to get diagnosed or treated because of “fear of the machine.”
She believes that with better education, those with sleep apnea will become more knowledgeable about and comfortable with using the machine as part of their treatment.
“There is a huge variety of equipment available,” she says. “If one doesn’t work for you, there are many others to try.” Even with insurance limitations, patients and their doctors can often negotiate with the insurer and medical equipment provider if they find a machine that works for them.
One of the goals of her research, which so far involves interviews with 60 people, is to find ways to educate those with sleep apnea about their treatment options, making them more comfortable with seeking help. Rodgers says she would like to include another 20 or so subjects in her research interviews, particularly people who have sleep apnea, but have been reluctant to seek treatment.
The ultimate goal is to find ways to help people seek and stick with treatment for their sleep apnea by finding the barriers that hold them back, plus strategies to overcome those barriers, says Rodgers.
“Sleep apnea is a public health issue because people falling asleep while driving can endanger others,” she says. The complications of untreated sleep apnea can be a significant financial burden for insurance companies, employers, and individuals as well.
And, it’s also a personal health issue.
“Once people are treated, they wish they would have done something sooner,” says Rodgers. One of those Rodgers interviewed in her research told her: “I had no idea how much better I would feel.”