As reported by The Hartford Courant, May 24, 2005.

Sleeping Unsoundly

By William Hathaway

Dr. Daniel McNally sometimes fell asleep before he could trade dollar bills for the baby teeth his daughters had tucked under their pillows.

In the morning, he used to say, "My snoring must have scared away the tooth fairy."

Years later, the director of the Sleep Disorders Center at the University of Connecticut Health Center was acting as a test subject for some new equipment in his own laboratory when a technician woke him in the night and told him he had sleep apnea.

"It was pretty obvious," McNally said.

In the decade since his diagnosis, McNally and other doctors have become better at recognizing the signs of sleep apnea, yet they say that millions of Americans remain undiagnosed. The public is blissfully unaware of the potential health dangers of the syndrome, which is marked by repeated and prolonged episodes of breathing cessation throughout the night. Snoring and daytime sleepiness are its chief symptoms.

Sleep apnea is now a well-recognized cause of cardiovascular disease and has been linked to diabetes and other disorders as well.

"Sleep isn't valued very much," said McNally, who now sleeps with a special apnea-preventing mask. "We sort of take it for granted."

That is a potentially dangerous mistake.

Apnea is Greek for "without breath," and those who suffer from it can literally stop breathing for more than 10 seconds, sometimes dozens of times a night. The upper airway becomes obstructed by excess tissue or large tonsils, or tongue and muscles controlling the airway relax and collapse during sleep. Sleepers are usually unaware of the problem.

Left untreated, sleep apnea can lead to high blood pressure, impotence, heart attacks and strokes.

About 12 million Americans have sleep apnea, and despite the rapid proliferation of sleep clinics across the country, at least another 10 million remain undiagnosed, according to the American Sleep Apnea Foundation.

Obstructive sleep apnea is the most common form of the syndrome and is caused when the soft tissue at the rear of the throat sags and blocks the airway.

Sleep apnea becomes more common as people age, and men are more susceptible than women. Being overweight and having a large neck are other risk factors. However, sleep apnea can affect women and people of all weights and ages.

Not everyone who snores has sleep apnea, nor does everyone who is sleepy during the day, said Dr. Asher Qureshi, director of the Sleep Disorders Center at St. Francis Hospital and Medical Center.

But, he said, "If you weigh 300 pounds, snore and are sleepy during the day, I would be much more likely to suspect sleep apnea."

People with sleep apnea tend to feel fatigued, even if they are in bed 10 hours or more. They often have morning headaches or dry mouth. Nodding off at stoplights and falling asleep in public places are other telltale signs.

One of the best indicators is a bed partner actually seeing or hearing the sufferer stop breathing during the night.

"In about 5 percent of the cases, people will wake up six or seven times a night," Qureshi said. "Sometimes, they say, they wake up choking."

Family doctors have become much better at identifying warning signs in recent years, he said.

The gold standard for diagnosis is a polysomnography, an overnight evaluation given at sleep centers, which can cost as much as $2,000 but is covered by many insurance policies. There technicians monitor such factors as oxygen levels, respiration, muscle tension, eye movement and snoring, and they document apneas, the frequency of which enables doctors to gauge the severity of the condition.

As more people have been diagnosed, treatments have steadily improved, said Dr. Kevin Krebsbach, an ear, nose and throat specialist at St. Francis.

"There has been an evolution, not revolution," Krebsbach said.

The standard of care for moderate and severe cases is a mask, called C-PAP for "continuous positive airway pressure." Pressurized air is pushed through the mask, forcing airways open. Today's masks come in a variety of styles designed to help patients sleep through the night.

By contrast, the first oxygen therapy given in the 1980s was nothing more than a vacuum cleaner with suction reversed, Qureshi said.

A variety of other devices have been developed to keep the airways open, and these have had some success alleviating mild to moderate forms of sleep apnea. In milder cases, losing weight, sleeping on one's side, or abstaining from alcohol sometimes can offer relief.

In more severe cases and for people who can't stand wearing a mask, surgery - which involves removal of tissue from the mouth or throat - may be recommended.

"Some people will do anything to avoid wearing a mask," Krebsbach said.