In today's world there is so much out there for us to do, so much to explore, and we can make any choice we want. People are different individually. We can wake up early or we can sleep in if we want. We can take a vacation across the world or we can stay at home and binge watch a series on Netflix. We can go to work and create a family but we don't have to if we don't want to. We can choose to design a rocket to launch into outer space or be a chef at a restaurant. We can be best friends but share different opinions. Whatever the case may be, we are all human and have the opportunity and privilege to choose what it is that we want to do or how we want to live.

BUT..... what is one thing that we all have in common that we HAVE TO DO? If you guessed sleep, then you are most definitely right- but we also have to be AWAKE! This is something all of us have in common - being asleep and being awake. Although many of us may have our differences in opinion, style, or hobbies, we can all relate to one another about what it is like to have a good sleep or a bad sleep. We can also relate on what the effects of a bad sleep or a good sleep can have on us when we have to live our day to day lives. Getting a good quality sleep is so valuable for us in today's busy world. It helps us perform in our daily activities, helps us focus, concentrate, process information and feel good while doing it. Getting bad sleep not only impairs our performace, cognitive function, and motivation, but it also causes our hormones to work differently and throws off our body's clock. An example of this is the hunger hormone. With bad sleep, our hunger becomes irregular- which can lead to wanting to eat more often and craving unhealthy food which then leads to weight gain, etc. The most serious part about bad sleep, is it also increases our risk factor for many health issues in the future such as stroke, heart attack, dementia and type 2 diabetes to name a few. 

The most amazing part about working in the sleep field is that it is still so underrecognized by today's society. Is it safe to say we all know what a cardiologist is? You get chest pain and ask to see a cardiologist. You feel like you are having problems breathing, you go to see a respirologist. If you break a bone, you go to the hospital for emergency care, get an X-ray and potentially have surgery because you probably should. But if you have a bad sleep, you blame it on going to bed too late, or having a "bad night" but those "bad nights" probably happen more often than you pay attention to. We are so busy, that even if we have a bad sleep we aren't bothered to investigate why, we are used to sleeping poorly and it becomes our new normal. We only worry and actually investigate when there is a reaction like pain or injury. Why not be more proactive? 

If you are the one getting chest pain your cardiologist will tell you a) "we didn't find anything abnormal" or b) "we found something abnormal". Have you ever thought to yourself that regardless of a or b, this issue may have arose from a different cause in the first place (que one of the many effects of possible sleep apnea...). How many people do you know that have high blood pressure? Did you know sleep apnea is a main cause of high blood pressure? Do you think these people have been tested for it? Maybe some have, but many probably have not. Many people take medication for high blood pressure instead of finding the root of the problem, which in often cases could stem from sleep apnea. Sleep apnea isn't just when you feel tired or have a bad sleep, it effects all of you as a person. Below I want to explain my views and understanding of sleep apnea and how I perceive the implications of it. I hope after reading this that you can also understand how important it is for you or your loved ones to be educated and treated if necessary. 

Sleep Apnea Explained by a Sleep Technologist:

When we fall asleep, we alter our state of conciousness. Being concious means that we are aware, we can see, smell, feel, hear and taste. Our body is operating at full capacity and we can choose to do anything we want (for the most part). We are easily stimulated. When we fall asleep, we change the state of our counciousness which allows for our nervous system, muscles, organs and many other physiological signals to relax. Although more relaxed, this does not mean they are not working. It means they operate differently and know it is time to switch to nocturnal functions. We are recovering from our day and recharging for the next one while our bodies are performing their nocturnal tasks for our organs to do this.

Generally speaking, there are two main reasons for sleep apnea. The first reason is that when the muscles in the upper airway relax, they relax to the point that it narrows or completely obstructs the airway, leading to restricted breathing or complete pauses in breathing. This can be due to extra weight on the airway and upper body, or simply to do with unusual airway anatomy. The second reason is due to an uncommon nervous system response that triggers the lungs and diaphragm to not work properly, causing complete pauses in breathing. 

We have different parts of the nervous system. To explain how this can effect sleep - while you are reading this your brain is telling you to keep reading and you are voluntarily continuing to read. You can tell yourself to move your right hand and your right hand will move (you just moved your right hand didn't you?). This is your somatic nervous system working. But, while you were telling yourself to read this, were you also telling your heart that it should keep beating? No, we don't control that. That is known as our autonomic nervous system which is still controlled from our brain however we don't get to fully control it. When we sleep, different parts of our brain become the nervous system's control centre for sending signals through the rest of our body during different stages of sleep such as: muscle tension, breathing, heart rate, kidney and pancreas function, etc. 

This is why some people have sleep apnea. Their upper airway becomes obstructed partially from muscle tone relaxing/too much weight, or a nervous system malfunction somewhere along the pathway to breathing properly. 

Now that we have gone over a little bit of the anatomy, what does this mean happens to us if we have sleep anea? Well it's simple really...

When we have pauses in breathing during sleep, it decreases our oxygen intake therefore our oxygen levels drop down to lower than they should be for brief periods of time. Also, for most people with sleep apnea, our bodies become aware we have been forced to stop breathing. After some time of paused breathing, we gasp for air which causes our body to move (slightly or a lot depending on the person, known as an arousal). This takes the body out of relaxation and therefore maintains a lighter sleep stage instead of getting into deeper, more restful sleep. The more often a person has these pauses in breathing, the more often their oxygen levels drop, the more often their body arouses when catching their breath, thus making the sleep apnea more severe. If we have one or two of these episodes over a 7 hour sleep, probably not a big deal - our bodies and symptoms won't change much. If we have hundreds of these episodes over a 7 hour sleep - you can now see why it may lead to feelings of tiredness throughout the day or having other medical issues arise due to constant low blood oxygen supply and less deep, restful sleep.

I would also like to point out that we calculate sleep apnea on a scale of mild, moderate or severe. When doing a sleep test, we count the total amount of respiratory events (pauses in breathing) and we divide it by the hours of sleep. This allows us to come up with an average of events per hour (ie: if you sleep for 7 hours and have 70 respiratory events total, your average events per hour = 10). A person with mild sleep apnea will have 5-15 breathing events per hour. Moderate is 15-30 breathing events per hour and severe is 30 or more breathing events per hour. 0-5 breathing events per hour is still considered normal and a person does not have sleep apnea. Would you believe we see people have over 30 events per hour more often than you'd expect? 

Now that you know this much, if you sleep 7-9 hours per night (approximately 1/3 of your lifespan), would you want to stop breathing 5+ times per hour? Thats 5 or more times every hour you are stressing your body out, causing a drop in oxygen, effecting the oxygen supply to all major organs. Keep in mind, 365 nights a year go by and someone with sleep apnea is doing this every night. Imagine the people who are doing it 30+ times an hour, how good can that be for maintaining your health? It cannot be good, there is no other answer! 

I want to explain something to all of you about people with sleep apnea and their symptoms. I believe this is very important in regards to people who think they may not have it and to raise awareness. I am going to explain two examples of sleep apnea and their related symptoms. 

In the first example, pretend there are 2 men, aged 50 years old. They both are the same exact height and weight and they both complain of the same exact symptoms (feeling exhausted, loud snoring, can't stay asleep - very typical sleep apnea or poor sleep related symptoms). They are pretty much identical! They both go for a sleep test and one of them only has mild sleep apnea but the other has severe. This happens ALL THE TIME. Just because one has worse sleep apnea than the other does not mean one is going to feel better than the other.

In the second example, pretend there are 2 women, aged 40 years old. They both are the exact same height and weight and they both aren't sure why they were sent for a sleep test by their doctor because they feel fine and they feel like they sleep fine. Again, they are pretty much identical! They both go for a sleep test and one of them tests positive for severe sleep apnea and the other tests negative for sleep apnea. This also happens ALL THE TIME. It is very common that people who have sleep apnea do not have symptoms. This is why so many people go undiagnosed. Some people may notice they are waking up a lot from the repeated pauses in breathing and others don't wake up from it at all. If you are like the lady who has severe sleep apnea and feels fine you are one of the lucky ones. A lot of people can't do that who test positive with a severe case. But what happens when you have severe sleep apnea for 5 or 10 years and it goes by unnoticed or has been left untreated? Your health risks remain the same for events like stroke, heart attack, dementia, diabetes and much much more, no matter how "good" you feel with it. What we try to explain to people is that treating sleep apnea is not just to make you feel better now but it is also to reduce and potentially prevent other risk factors for later in life. Again, this is why it is so important to be tested. You sleep every day and you want to make sure that your body is at optimal health for your future. Not just for your own sake, but for your family to enjoy more time with you and for your kids and loved one's to know that you are healthy. Bringing you back to the mild/moderate/severe scale, there are many patients who show over 100 breathing events PER HOUR and they are still not convinced they have a problem. This is how unaware some people can be of their sleep and how symptoms can trick us! 

I have met many people (and the majority of these people in this example being men) who are stubborn. We don't really care about problems, we will fight through them and push them off to a later date. This is a lot of the time the mentality I see with sleep apnea. I know some of us might not worry about ourselves as much as we should. Although you may not worry about yourself, do you think your family might? Having a family member in poor health is something that nobody wants to experience. When we do experience it, it leaves us with a sad, painful, helpless feeling that is hard to explain. If you won't do it for you, do it for your loved ones. I am sure there is honour and respect in that, and they may even get to spend time with a healthier you for longer! 

You see, sleep for your health is like the foundation of a house. If the foundation is strong and doing what it is supposed to do it will allow the house to be built properly and maintain itself well. Sure things might go wrong with the house here and there, but I bet you problems arise much less often and much later in time than if the foundation is bad. If the foundation begins to break, so does the rest of the house. When you fix the wall that rotted out because of the break in the foundation, you are only putting up a new wall until another wall breaks. But, if you immediately fix the foundation, your new wall will remain the way it should and you won't have to worry about as many damages happening in the future. You want a good foundation to your health and living with sleep apnea is like having a broken foundation. You want the foundation to be good so you can elimate risks of things going wrong. That doesn't always mean things won't go wrong, but you are definitely improving your odds! 

I hope this article has helped you understand sleep apnea a little bit more. Please feel free to share it with family and friends. If you have any questions for me my business number is 226-776-8891 and I would love to answer any questions you may have and discuss sleep with you further. I hope this has helped people see the importance of sleep health from a different perspective, and that we can make it become more recognized throughout the world one night's sleep at a time! 

Joel Clarke RPSGT, RCT

Executive Director

Restwell Inc.