39 times an hour: Late diagnosis of sleep apnea

Eric Diehl got tired of waking up weary and napping at midday, but he never dreamt he had a life-threatening condition.

"I'm a retired judge from the provincial court and I found that I was having to rest a lot between noon and the reconvening of court at 2 o'clock," he said. "My wife was also telling me that I was a very, very heavy snorer, but I didn't take it seriously and let appointments drift by when I shouldn't have."

When he was finally diagnosed with sleep apnea, tests showed Diehl was waking up 39 times an hour overnight.

"I wasn't conscious of that but obviously when you're waking up like this you're suffering all of the impacts of lack of sleep," he said. "Your powers of concentration go down, your ability to read well just drops."

Sleep apnea is a condition where the airway collapses during sleep. Loud snoring can mark the condition followed by lapses, where there's no sound and then a great gasp as breathing resumes.

After he was diagnosed, Diehl was fitted with continuous airway pressure equipment (CPAC) in 2004.

"Once I was put on this equipment, I was able to put in a regular night's sleep without any trouble at all," said Eric, who serves on the board of the Lung Association of Saskatchewan.

During the day, his endurance and energy has improved "beyond all expectation," he's more relaxed, his risk of heart attack and stroke is reduced and his driving habits and memory have improved.

The untreated condition can lead to many problems.

"During the time that breathing isn't occurring, the body gets very excited, the heart tries to beat faster and it leads to things like high blood pressure, heart attacks and stroke," Dr. Brian Graham, the President of the Lung Association of Saskatchewan, said.

Falling asleep behind the wheel is another deadly consequence.

"There's a huge increase in traffic collisions for people with sleep apnea," he said. "In various studies, it's anywhere from three to seven times as high."

That's important because sleep apnea is more common than you might think: obstructive sleep apnea (OSA) is the most common category of sleep-disordered breathing. The prevalence of OSA among the adult population in western Europe and North America is estimated to be 3-4% of women and 6-7% of men, according to Wikipedia.

Advice to partners of snorers: Show them this.

Browse for related stories in the index at the very bottom of this page, or read a late diagnosis story.

Thanks to the Saskatoon Star-Phoenix of Jan. 2 for the source story.

I did it to myself, and so I better do everything I can to get out of it: Missed diagnosis of COPD

The crisis came five years ago for Jean Rommes, on a Monday morning when she had planned to go to work but wound up in the hospital, barely able to breathe. She was 59, the president of a small company in Iowa. Although she had quit smoking a decade earlier, 30 years of cigarette smoking had taken their toll.

After several days in the hospital, she was sent home tethered to an oxygen tank, with a raft of medicines and a warning: "If I didn't do something, life was going to continue to be a pretty scary experience."

Jean has chronic obstructive pulmonary disease, or C.O.P.D., a progressive illness that permanently damages he lungs and is usually caused by smoking. She has both emphysema and chronic bronchitis, as well as asthma. She had symptoms for years before receiving a correct diagnosis.

She began smoking in college in the 1960s, when she was 18. People whom she admired smoked, and it seemed cool. She smoked for 30 years.

When she quit in 1992, it was not because she thought she was ill, but because she realized that she was organizing her day around chances to smoke. But she almost certainly was ill. She was only 50, but climbing a flight of stairs left her winded. From what she found in medical dictionaries, she began to suspect she had lung disease.

By 2000 she was so short of breath that she consulted her doctor about it.

He gave her a spirometry test. In one second, healthy adults should be able to blow out 80% of the total they can exhale; her score was 34%, indicating moderate to severe lung disease.

"I don't know whether he knew," she said of her doctor. "I suspect he did, but he didn't call it emphysema. He put me on a couple of inhalers and he called it asthma. I sort of ignored the whole thing because the inhalers did make me feel better. I started to gain some weight, and things got progressively worse."

She cannot help wondering now if she could have avoided becoming so desperately ill, if she had only known sooner what a dangerous illness she had.

The turning point came in February 2003 when she tried to take a shower and found that she could not breathe. The steam all but suffocated her. She managed to drive from her home in Osceola, Iowa, to her doctor's office, struggle across the parking lot like someone climbing a mountain and collapse, gasping, onto a couch inside the clinic. Her blood oxygen was perilously low, two-thirds of normal, even when she was given oxygen. The hospital was next door, and her doctor had her admitted immediately.

She had Type 2 diabetes as well as lung disease, and her doctor told her that losing weight would help both illnesses. But she said, "He made it pretty clear that he didn't think I would or could."

Motivated by fear and anger, she began riding an exercise bike, walking on a treadmill, lifting weights at a gym and eating only 1,200 to 1,500 calories a day, mostly lean meat with plenty of vegetables and fruit.

"I came to the conclusion that if I didn't, I probably wasn't going to be around," she said. "I wasn’t ready to check out. And my husband was beginning to show the signs of Alzheimer's disease."

By December 2003, her efforts were starting to pay off. She went from needing oxygen around the clock to using it only for sleeping, and by January 2005 she no longer needed it at all. She was able to lower the dosage of her inhalers and diabetes medicines. By February 2005, she had lost 100 pounds.

The daily exercise also helped her deal with the stress of her husband's illness.

"I had no clue that exercise would do as much for ability to breathe as it did," she said, adding that it helped more than the drugs, which she described as "really pretty minimal."

"Exercise is absolutely essential, and it's essential to start it as soon as you know you have C.O.P.D.," she said.

"I will tell pretty much anybody that I smoked for 30 years, and I quit in 1992." Maybe it's why I've attacked this the way I did. OK, I did it to myself, and so I better do everything I can to get out of it. We all do things in our lives that are stupid, and then you do what you can to fix it."

Advice to former smokers: Exercise will help your lungs function better.

Browse for related stories in the index at the very bottom of this page, or read one of our COPD stories.

Thanks to Denise Grady for the source article in the Nov. 29 issue of the New York Times.