Case Study: Sleep Apnea and Marriage

"When sleep problems develop, a good night’s sleep is often hard to come by for both bed partners." 

— Steven Lamm, M.D.

Steven Lamm, M.D., has reported extensively on a variety of medical issues on television and radio. A great communicator, Dr. Lamm has been the long-time medical correspondent for The View (ABC-TV) because of his ability to talk to women about their important health issues, and the health issues of the men they love. As a practicing Manhattan internist for over twenty-five years, Dr. Lamm has provided medical care and compassion to thousands of patients. Dr. Lamm has published four books that have explored the intersection of medicine, science, and health.

Some chronic sleep problems are shared by many married couples but certainly not willingly. Spouses will spend more time in bed together than anywhere else during their marriage, but when sleep problems develop, a good night’s sleep is often hard to come by for both bed partners. 

Jane was frustrated and certainly very fatigued, which made it hard for her to function at her job as a TV producer. She never thought “sleeping together” with her husband would be such an ordeal and for 18 years it had been anything but that. But lately Jane was losing sleep each night, not because she had trouble sleeping but because her husband did. 

Hank’s constant snoring was now something new in their relationship. Hank vehemently denied that he snored, which caused a rift in their relationship, while Jane suffered and tried to deal with it. But with both losing sleep because of it, the snoring almost drove them to divorce.

Jane did her best to avoid the ear-splitting noise. She’d go to bed before Hank’s snoring began. Jane’s strategy rarely worked. Hank snored throughout the night, interspersed hundreds of times by a pause in his breathing, and followed by a snort and what appeared to be a gasp for air. 

Awakened by the snoring, Jane often tossed and turned, counting backwards from 2,000, turning the light on and reading a trashy novel, trying anything she could to get back to sleep. Needless to say, neither Jane nor Hank woke up well rested.

As the weeks of fitful sleep turned into months, both had frayed nerves and a developing sense of animosity towards each other. They had gone so far as to plan to sleep in separate rooms—something neither looked forward to doing. Luckily, this bedroom battle ended amicably after a joint visit with me one Monday morning following a heated weekend-long discussion.

An All-Too-Familiar Culprit 

Heavy snoring can signal other health problems, but Jane’s vivid description of the pauses and gasps for air between her husband’s snoring was a red flag for obstructive sleep apnea. I briefly sketched out sleep apnea for them, explained how it was most likely causing Hank’s poor sleep, and how it could now be definitively diagnosed. OSA Overview

From my shelf, I took down the WatchPAT home sleep apnea monitor and showed Hank and Jane how easily it worked, and what I wanted Hank to do that night with the WatchPAT. More About WatchPAT

Jane was visibly relieved that at last some progress was being made in getting much-needed medical help for her husband; and happy, too, that Hank didn’t have to go for a night’s worth of testing at the sleep lab.

I told her that this was an all-too-common reaction. During the all-night hospital test, sensors would be attached to Hank’s head, face, chest, abdomen and legs and transmit data on changes in his breathing, blood oxygen levels, and how many times he woke up.

WatchPAT Results

A day later, I reviewed Hank’s WatchPAT results on my computer screen: Moderate sleep apnea was the diagnosis.

I explained to Hank that he had indeed developed sleep apnea, a dangerous sleep-robbing and life-threatening condition common to men and women in their 40’s and 50’s that’s now linked to close to 38,000 cardiovascular deaths a year.

The cause of apnea in Hank’s case was very likely the25 extra pounds he had put on over the course of the past year due to a painful knee injury that had curtailed his daily three-mile runs in Central Park. Some of this weight was now in his neck and face, and when he went to bed it caused a repeated collapse of tissues in his upper throat, blocking the passage of air as he slept. That led to the snoring and to the deadly moments when Hank was not breathing.

I explained to Hank that since he had trouble breathing while he slept, he spent little of his nighttime hours in the deep-sleep stages that are so essential for good rest. That’s why he was waking up feeling tired and was sleepy throughout the day.

But there were solutions for his sleep apnea and it was up to him to decide what he wanted to try.

Sleep Stages

Sleep is divided into two distinct types: Non-REM (NREM) sleep and rapid eye movement, or REM, sleep. When you first go to sleep, you begin NREM sleep, also known as “quiet sleep,” and then go through four distinct phases, each one progressively deeper than the other. In Stage I your muscles begin to relax, your breathing becomes regular, and body temperature starts to drop. You can be awakened easily from this early and shallow stage of sleep.

During Stages II and III your sleep becomes deeper, with your body processes slowing down. It’s difficult to awaken you, and if you are suddenly awakened, you may be groggy or startled and not know where you are. Delta sleep, or Stage IV sleep, is thought to be the restorative stage when the body goes about its various repair functions.

During REM sleep, the next phase, your mind is hyperactive but focused. Your blood pressure soars and sinks low at this time. Your heart rate races and slows, and your breathing pattern is uneven. Blood flow to your brain increases.Dreams are common and often vivid. Erections are also common, as are engorgements of the clitoris. Except for a quick fluttering back and forth of your eyelids, there is no noticeable physical motion while you are in REM sleep because your body’s motor system has been shut down.

A typical sleep cycle begins with NREM sleep and ends with REM sleep, the two combined cycles lasting a total of 90 to 100 minutes. This sleep cycle is repeated four to five times duringthe night. Early at night the REM period may only be five minutes long but it may stretch to an hour as the night progresses. However, if you are a poor sleeper like Hank was because of his sleep apnea, you may spend less time in Stage IV and REM states, with your sleep cycles seriously fragmented and disrupted by periods of wakefulness. Sleep 101

Hank’s Sleep Apnea Therapy

After reviewing the WatchPAT results with Hank and Jane, I then detailed the possible treatment options, which included a CPAP (Continuous Positive Airway Pressure) device, a dental appliance, and several surgical possibilities.OSA Treatment Options

After thinking it over, Hank decided to try CPAP and I then made arrangements for him to be set up with a CPAP system. CPAP, by far the most common treatment for sleep apnea, uses a device that pushes air through the airway to keep it open during sleep.

A few weeks later,a refreshed-looking Hank returned to my office for a follow-up visit and another WatchPAT sleep test. He had been sleeping with a small nose mask that delivers air pressure through tubing connected to a small CPAP unit by the side of his bed. This keeps his air passages open, puts an end to snoring, and allows him to sleep uninterrupted for eight hours.

“I can’t believe the difference in how I feel,” he said. “And Jane is ecstatic.”

While he was now sleeping soundly, Hank still needed to lose weight. Since he couldn’t run, I encouraged him to cut back on the fat-laden foods he liked and to get to his local swimming pool four times a week for some lap swimming. By losing weight, he might be able to eliminate the sleep apnea entirely. “I’d seen it happen before with many of my patients with sleep apnea,” I told him.

The good news: With quiet finally restored to their bedroom, both Jane and Hank now sleep—and feel—much better. That’s what they jotted down on the postcard they recently sent me from Paris, where they’d gone to celebrate their second honeymoon.

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