Obstructive Sleep Apnea (OSA) has long been though of as an overweight man’s disease. The stereotypical patient snores loudly, stops breathing for long pauses, shakes the bed, and is impossible to sleep with! But this stereotype may be contributing to significant deleterious health consequences for people with a normal Body Mass Index (BMI), and especially for hypermobile women.
While age and weight are increased risk factors, OSA is an epidemic cutting across a much broader swath of our population. And regarding the male/female prevalence of OSA, a recent Swedish study of 400 women found severe sleep apnea was present in 31% of obese women aged 55-70 years old. But the surprising figure from this study was that 50% of all the women tested (age range 20-70) were positive for OSA.
These results mirror a growing trend we previously noticed, especially in hypermobile patients, the majority of which were female and slender. These patients complained of fatigue, excessive daytime sleepiness, and morning headaches. Worsening migraine was a major complaint for some. When a polysomnogram (sleep study) was carried out to investigate their sleepiness complaints, they were found to have something they had never considered… obstructive sleep apnea, with fragmented and disrupted sleep.
Many hypermobile patients, many of whom are young and slender, have sleep disordered breathing, or mild sleep apnea, as an explanation for their fatigue. In an involuntary attempt to open up their airway and breathe better when they sleep, these patients frequently extend their necks to breathe, in much the same way health care workers extend a patient’s neck to introduce an airway to help a patient breathe. This can lead to morning headaches.
These hypermobile patients usually recognize that their sleep patterns are not normal, and that their sleep is non-restorative. Many have been prescribed a sleep aid by their family physician. These sleep aids are frequently medications called sedative-hypnotics, that work by various mechanisms on the neurologic structures that mediate sleep. They can force sleep through events that would ordinarily interrupt sleep, like involuntary leg movements, or obstructive airway events, or both.
Sleep aids are one of the fastest growing segments in the pharmaceutical industry, growing 23% from 2006 through 2010. However, if a sleep-related breathing disorder, like OSA, is the root cause of a patient’s sleep problems, most of these medications can actually make things worse. One study of over 10,000 sleeping pill users found a 5.3 times higher rate of death, causing the authors to claim that sleeping pills could be “as risky as cigarettes”. Though these medications are safe when used appropriately in patients who have had their sleep complaints investigated by a Board Certified Sleep Medicine Physician, they should be used with caution in all patients with chronic sleep complaints.
Fortunately, there is a better treatment alternative to overmedication with sleeping pills. That alternative is finding out the root cause of the sleep problem, and fixing that. This could be leg movements, sleep-related breathing disorders, a combination of the two, a circadian or “clock” disturbance, or a host of other identifiable disorders that can be identified and treated by a Sleep Disorders Specialist who is Board Certified in Sleep Medicine.
A study published in the American Journal of Respiratory and Critical Care Medicine was the first placebo-controlled study to use sham CPAP therapy in sleepy patients with mild to moderate OSA. It showed that PAP treatment effectively reduced symptoms of sleep apnea and improved quality of life in these patients.
The video below is representative of the life changing difference that CPAP therapy can make… even in slender females!