Do you snore?  Are you overweight?  Do you feel tired, overstressed or depressed?  Of course not, because if you did you wouldn't be reading this.  Let's start again.

Does someone you know snore?  Pauses in her/his breathing?  Is he/she overweight? Awakens unrefreshed?  Falls asleep on the couch immediately after getting home from work?

Diagnosis:  OSA = Obstructive Sleep Apnea.  It means your throat closes off whenever you sink into deep sleep.  And it is rampant!

Unfortunately we all need deep sleep every night to recharge our mental batteries.  Some people with OSA go years without a decent night's sleep.  If you get stressed or sad after a single night of poor sleep, try doing it every night for years!

I see people like this almost every day in my office.  The medical texts say it is massively underdiagnosed, too.  I have become so attuned to obstructive sleep apnea that my spidey senses start tingling as soon as I open the exam door.  I see the tell-tale droopy eyes.  Not the subtle droopy eyes of boredom or transient tiredness.  This is a chronic droop, maybe with a crease under the eyelid.

I ask the questions about feeling tired, morning headaches, anxiety.  About 3/4 of the time I note the enlarged neck size (17 inches for men, 16 inches for women).  I ask about falling asleep while driving (1/2 of people tell me yes).

I glance at the elevated blood pressure (~90% have it).  I look for signs of advanced disease, in which the sleep apnea is straining the heart.  Swollen ankles are a later sign of this.

Outrageously, I have discovered that my mere suspicion of sleep apnea is diagnostic!  Sounds audacious, I know.  So my next step is to suggest the person get a sleep study.  Over 90% of the time, the test shows obstructive sleep apnea.

Often we have to do a second sleep study to test the efficacy of the CPAP (continuous positive airway pressure) device.  It almost alwasy shows some benefit.  The trick is to see whether the person will tolerate sleeping with a mask over their face.

I am waiting for better diagnostic methods (at home testing) and treatments (oral devices to prop the airway open) to come of age.  Probably within the year.  Until then I am left with unsatisfactory tools to combat this pervasive condition.  I can't wait.  My theory is that once we get better treatments (and if we can ever get a hold on obesity) then the roads will be a lot safer.

Sleep well,