Millions of people in Canada suffer from sleep apnea. The problem is that they don’t all realize it.


The dose26:00What should I know about sleep apnea?

Sleep apnea is a medical condition in which breathing stops and starts several times during sleep. Although it is a fairly common condition, an estimated eight in ten Canadians live with undiagnosed sleep apnea. Sleep physician Dr. Sachin Pendharkar explains how sleep apnea works, as well as the options available to diagnose and treat this disorder.

Krista Biddiscombe never thought she was living with sleep apnea.

Biddiscombe, 58, spent more than a decade unable to sleep, visiting family doctors in two provinces who misdiagnosed her symptoms as perimenopause. Working in a high-stress political role for the federal government, he was prescribed sleeping pills and muscle relaxers that improved his sleep, but they did not cure his condition.

Finally, in 2023, after Biddiscombe moved to Alberta, she saw a doctor who suggested she might have sleep apnea.

She now uses a continuous positive airway pressure (CPAP) machine to sleep and says sleep is “a whole different world.”

“When I fall asleep, I stay asleep,” she says.

Although millions of Canadians suffer from the same problem, disrupting sleep and increasing the risk of other health problems, many are unaware of it, doctors say. Sleep apnea is treatable, but cost and access can vary widely across Canada.

What is sleep apnea?

There are two main types of sleep apnea: obstructive sleep apnea and central sleep apnea.

Obstructive sleep apnea is the most common. People with this condition experience a collapse of their upper airways during sleep, leading to “recurrent interruptions in breathing,” according to sleep and respiratory disease physician-scientist Dr. Sachin Pendharkar.

He described it as a “mechanical problem.”

“What is normally a nice open airway, like a pipe that we can breathe through, begins to gradually narrow as these muscles relax,” Pendharkar said. The dose welcome Dr. Brian Goldman.

A man in a white coat smiles at the camera.
Dr. Sachin Pendharkar, a sleep physician and medical director of Foothills Medical Center Sleep Center in Calgary, estimates he has diagnosed hundreds of patients with sleep apnea. (Submitted by Sachin Pendharkar)

Central sleep apnea, on the other hand, is a “signaling problem,” in which the brain fails to accurately send breathing signals while people sleep, Pendharkar said.

Sleep apnea tends to affect men more than women, but approximately 5.4 million Canadians live with this disease. According to Pendharkar, who is also medical director of the sleep center at Foothills Medical Center in Calgary, an additional 80 per cent of people with sleep apnea go undiagnosed.

What are the symptoms of sleep apnea?

People with sleep apnea often report normal sleep levels and are usually able to stay asleep throughout the night.

But they wake up feeling like they haven’t rested at all.

“It kind of extends into the day,” Pendharkar said. “They feel sleepy during the day, they may have difficulty concentrating or alertness.”

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This may be the cause of that loud snoring or morning headache. Additionally, people who have it are more likely to suffer from illnesses such as heart disease and depression. It’s called sleep apnea, and many Canadians are at risk of serious health effects from it. But surprisingly few people are aware of it.

Snoring is also a common symptom of sleep apnea. But it can be difficult for people without a bed partner to know if they snore.

If left untreated, sleep apnea can lead to a host of medical problems, including heart disease, type 2 diabetes, and high blood pressure.

In some cases, untreated sleep apnea can also lead to neurological problems, according to Dr. Andrew Lim, a neurologist at Sunnybrook Health Sciences Center who specializes in sleep disorders.

A man in glasses smiles at the camera.
Dr. Andrew Lim is an associate professor of neurology at the University of Toronto and a neurologist at Sunnybrook Health Sciences Centre. (Doug Nicholson)

In the long term, people are at higher risk of developing strokes, cognitive impairment and dementia, according to Lim, who is also an associate professor of neurology at the University of Toronto.

Biddiscombe’s undiagnosed sleep apnea led to mental health issues, memory problems, and other complications.

“At one point, I remember sitting on my couch, and I can’t describe it any other way, but it actually felt like my internal organs were rotting because I was so exhausted,” she said. she declared.

How to diagnose sleep apnea?

Plisomnography is the “gold standard” for diagnosing sleep apnea, according to Pendharkar.

“It’s an overnight sleep study in the lab where the patient goes to the lab,” he said. “They’re connected to a whole bunch of different equipment.”

The machines measure brain waves, muscle activity, breathing and oxygen levels, among other things, while the microphones also record the sounds patients make while they sleep.

However, laboratory tests are not accessible everywhere.

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In 2005, Canadians slept an average of eight hours a night. By 2013, that figure had dropped to seven. Today, about 40 percent of Canadians suffer from a sleep disorder. Something about sleep keeps our bodies and minds from falling apart. Its absence has been linked to obesity, heart disease, stroke, diabetes and depression. Researchers are now discovering some fascinating things about the importance of sleep in how our brains store memories and learn things.

“In some parts of Canada and even other parts of the world, it’s difficult for people to access a lab because there just aren’t enough lab resources,” Pendharkar said.

“And so, over the last 20 or 30 years, there has been the emergence of what we call home sleep apnea tests.”

Biddiscombe, who lives in Sherwood Park, Alta., was not offered a lab test. Instead, she relied on a take-home test.

“It’s quite a gimmick,” she said. “You have to tape this mask to your face, you have a microphone attached to your neck, you have a (pulse oximeter) attached to measure oxygen levels… you have tape everywhere and then you’re supposed to sleep.”

Pendharkar says experts look for reductions in overall airflow, drops in oxygen, changes in blood oxygen as well as snoring.

“It’s the same whether you do the test at home or in the lab,” he said.

Testing costs vary depending on whether the study is conducted in a laboratory or at home. Comprehensive laboratory sleep studies are covered by many provincial health insurance plans, but at-home tests are sometimes paid for out-of-pocket by patients. In Biddiscombe’s case, her take-home test was free.

How to treat sleep apnea?

After her home sleep study confirmed her sleep apnea diagnosis, Biddiscombe purchased a CPAP machine for about $2,400 to help her breathe while she slept.

Pendharkar says CPAP machines are the “first-line and gold standard” treatments for sleep apnea.

“Basically it’s a little box that sits on the bedside table, connected to a tube, connected to a mask that fits either over the nose or over the mouth and nose,” he said. he declares. “The box blows pressurized air through the mask and basically blows air into the airway to keep it open and prevent it from collapsing.”

CPAP users can adjust the amount of pressure needed to keep their airways open.

Some people with mild to moderate sleep apnea may also benefit from a mandibular advancement appliance, a type of dental appliance that pulls the lower jaw forward to improve breathing.

“These are actually really good treatments to reduce not only the number of these respiratory events, but also to improve sleepiness and quality of life,” Pendharkar said.

Pendharkar acknowledges that some patients have difficulty adjusting to sleeping with a CPAP mask.

Biddiscombe started with a mask that covered his nose, which quickly proved uncomfortable.

“My nose hurt so much it wasn’t even funny,” she said. “I spent the whole day making sure he was constantly covered in Vaseline. It was horrible.”

Despite the discomfort, her CPAP machine worked.

“I actually finally got to sleep,” Biddiscombe said.

Pendharkar recommends consulting a healthcare professional before purchasing a CPAP machine.

It should also be noted that both US Food and Drug Administration And Health Canada have been informed of a recall of certain models of Philips CPAP devices due to health risks.

Equal treatment for sleep apnea remains out of reach

Pendharkar studied the cost of treating sleep apnea across Canada. Ontario, Saskatchewan and Manitoba are currently the only provinces to fund CPAP treatments through government programs, he said.

“Everywhere else in the country there are programs for people who are very low income, but otherwise people pay out of pocket through private insurance,” he explained.

“Which is a shame, because I think it really limits access.”

Biddiscombe hopes additional regulation can equalize the cost of CPAP machines – across the country.

“I don’t understand why someone in Ontario can buy the exact same machine as me for $800, but I’m in Alberta paying $2,400,” she said.

Even with the device, she says she still doesn’t sleep fully seven to nine hours recommended by doctors.

A photo of a continuous positive airway pressure machine.
A continuous positive airway pressure machine, also known as a CPAP machine, is considered the gold standard treatment for sleep apnea. (Jean Delisle/CBC)

“I think it’s just life and work and other stressors that come into your life at my age,” she said.

Since being diagnosed and starting to use a CPAP machine, she says she has seen a noticeable improvement in her health and well-being.

“I have more energy, I have more cognitive abilities than before, I can actually concentrate,” she said.

She hopes women — especially those in perimenopause — will learn from her overall experience navigating the medical system.

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