Asleep at the wheel?

The craving for sleep was ncredible. My eyelids wanted to slide shut so steep could flow in. Unfortunately, I wasn't safely in bed. I was driving my car.

I lost the fight to keep my eyes open. The ka-thump of tires against concrete curbing jarred me awake. Fortunately I hadn't hit anything but the curb. I was so scared, though, I sat there shaking for five minutes. I didn't know what was wrong with me. For a couple of months I had been incredibly sleepy. Failing asleep at the wrong times, such as while driving, had become commonplace. I spent eight to ten hours a night in bed, yet I awoke each morning feeling more fired than when I went to bed the night before.

I eventually learned that I have a dangerous illness known as sleep apnea. In simplest terms, when persons with apnea go to sleep, they stop breathing for short periods of time. Apnea robs them of energy, causing them to fall asleep at inappropriate times, and can be the harbinger of heart attack, stroke, or hypertension.

The two major symptoms of sleep apnea are excessive daytime sleepiness and "world-class" snoring. I have been a snorer for most of my life. Episodes of daytime sleepiness had occurred off and on for years. In mid-1987, though, both the snoring and sleepiness became severe.

Fortunately that year I heard about a sleep disorders clinic. I went through a sleep study and learned that I had severe obstructive sleep apnea.

Apnea is dangerous. According to Dr. Dale Rice of the Los Angeles County Medical Center, sleep apnea victims are literally "near death" when they sleep. "It's like going to war with yourself every night," he says.

Heart at risk. Why are apnea victims prone to hypertension, heart attacks, and stroke? Because the body is deprived of oxygen at times throughout the night, causing blood gases to go berserk.

"The oxygen content of the blood decreases and the carbon dioxide levels increase during apneic periods. This means that heart, brain, and other vital tissues are periodically deprived of needed oxygenated blood. The daytime sleepiness is actually caused by the lack of oxygen at night," says William Baird of the American Narcolepsy Association.

"Furthermore, during the apneic episodes there are serious abnormalities of the heart and blood vessels. The blood pressure rises sharply in both the pulmonary and systemic arteries, and the heart slows and may stop entirely for as long as six to eight seconds," he adds. Heart attacks that occur during sleep are often apnea related.

Types of apnea. The two kinds of apnea are central apnea and obstructive apnea. The first is caused by a brain mallunction, the other involves obstruction of the airways.

Central apnea is rare and is usually treated with drugs. In central apnea the brain stops sending messages to the muscles controlling the diaphragm, and breathing stops. Only when the person starts waking up do messages start flowing again.

In obstructive apnea, muscle tone is lost and excessive throat tissue collapses during sleep, blocking the airways. The victim starts gasping for air and wakes up. In an instant, muscle tone is restored, the airways open, and breathing resumes for a short while. After a few breaths, breathing may again stop. The cycle repeats itself hundreds of times each night. However, apnea victims rarely recall any apneic episode or of waking up to breathe.

World-class snoring. A classic apneic symptom is "world-class" snoring-snoring so loud and penetrating that it's impossible to sleep in the same room with the snorer, sometimes even the same house.

While the din of snoring is disturbing, the silence of an apneic episode can be more terrifying. An apneic can stop breathing 30 to 90 times an hour, with the duration of an episode lasting as long as a minute or more.

The result of interrupted breathing at night means excessive daytime sleepiness. This isn't an occasional yawn or brief periods of drowsiness after lunch. Excessive sleepiness includes falling asleep or struggling to stay awake during meetings, at your desk or machine, while eating meals, waiting for appointments, and driving. If you need a nap every few hours, then apnea is a real possibility.

Help available. Treatment for apnea may involve surgery or the use of nonsurgical devices. A surgical treatment commonly known as a throat lift removes excess tissue from the throat, back of the tongue, and other areas where air flow is restricted. It's effective in treating most snoring cases and 50 to 60 percent of severe sleep apnea.

For less severe cases a dental device can be used while sleeping that depresses the back of the tongue and helps keep air passages open.

Many apneics opt for a nasal device called a CPAP, which stands for Continuous Positive Airway Pressure. The CPAP is basically a blower connected to a special mask the apneic wears over his nose while sleeping. Air is gently forced through the user's airways, keeping them open and enhancing normal breathing.

I've had success with a CPAP in keeping my apnea under control.

Symptoms of apnea typically first show up in overweight males in their mid- to late 40s. So losing weight and exercising regularly can be beneficial for mild cases of apnea. In fact, lifestyle change is what eventually ended my apnea problem. After being diagnosed, I changed my diet to mostly fruits and vegetables. I exercise regularly, walking 45 minutes to an hour at least five days a week. I've lost 130 pounds, going from more than 300 pounds to 183 pounds. Today I no longer need a CPAP. I sleep soundly six to seven hours a night, wake refreshed, and rarely experience daytime drowsiness.

If you're drowsy during the day, a sleep disorders clinic can determine whether apnea is the cause. There are more than 200 certified sleep disorder facilities across the country.

At the clinic you will have an extensive evaluation, including a sleep study where you spend a night at the clinic with sensors hooked up to your scalp, face, chest, and legs. Brain waves, respiration, blood pressure, muscle response, and other characteristics are measured to give the best possible picture of your sleeping traits.

Sleep apnea is a serious, potentially fatal disorder. Fortunately, its effects can be controlled--if not eliminated-by a variety of treatments now available through physicians specializing in sleep disorders.