The Dose26:00What do I need to know about sleep apnea?
Sleep apnea is a medical condition in which breathing stops and restarts many times during sleep. Despite being a fairly common condition, an estimated eight out of 10 Canadians live with undiagnosed sleep apnea. Sleep physician Dr. Sachin Pendharkar explains how sleep apnea works, as well the options available for diagnosing and treating the disorder.
Krista Biddiscombe never thought she lived with sleep apnea.
Biddiscombe, 58, spent more than a decade unable to sleep, consulting with family doctors across two provinces who misdiagnosed her symptoms as perimenopause. Working in a high-stress policy role for the federal government, she was prescribed sleeping pills and muscle relaxants that improved her sleep, but they didn’t cure her condition.
Finally, in 2023, after Biddiscombe relocated to Alberta, she consulted with a doctor who suggested that she might have sleep apnea.
She now uses a continuous positive airway pressure (CPAP) device to sleep, and says sleep is “a whole other world.”
“When I fall asleep, I stay asleep,” she said.
While there are millions of Canadians with the same condition, disrupting sleep and increasing the risk of other health problems, many don’t know it, doctors say. Sleep apnea is treatable, but the cost and access can vary a lot across Canada.
What is sleep apnea?
There are two main kinds of sleep apnea: obstructive sleep apnea and central sleep apnea.
Obstructive sleep apnea is the most common. People living with the condition experience a collapse of their upper airway during sleep, which leads to “recurrent interruptions in breathing,” according Dr. Sachin Pendharkar, a sleep and respiratory physician-scientist.
He described it as a “mechanical problem.”
“What is normally a nice open airway, like a pipe that we can breathe through, starts to narrow progressively as those muscles relax,” Pendharkar told The Dose host Dr. Brian Goldman.
Dr. Sachin Pendharkar, a sleep doctor, and medical director of the Foothills Medical Centre Sleep Centre in Calgary, estimates that he’s diagnosed hundreds of patients with sleep apnea. (Submitted by Sachin Pendharkar)
Central sleep apnea, on the other hand, is a “signal problem,” in which the brain fails to accurately send breathing signals while people are asleep, Pendharkar said.
Sleep apnea tends to affect men more than women, but roughly 5.4 million Canadians living with the condition. According to Pendharkar, who is also medical director of the Foothills Medical Centre Sleep Centre in Calgary, an additional 80 per cent of people living with sleep apnea are undiagnosed
What are the symptoms of sleep apnea?
People living with sleep apnea often report normal levels of sleep and are usually able to stay asleep throughout the night.
But they wake up feeling as though they haven’t rested at all.
“It sort of carries over into the day,” Pendharkar said. “They’re sleepy during the day, they might have difficulty with concentration or alertness.”
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It may be to blame for that loud snoring, or morning headache. Plus, people who have it are more likely to suffer from things like heart disease and depression. It’s sleep apnea, and a large number of Canadians are at risk of the serious health effects that come with it. But surprisingly, few are aware of it.
Snoring is also a common sleep apnea symptom. But it can be difficult for people without bed partners to know whether they snore.
If left untreated, sleep apnea can lead to a host of medical conditions, including heart disease, Type 2 diabetes and high blood pressure.
In some cases, untreated sleep apnea can also lead to neurological concerns, according to Dr. Andrew Lim, a neurologist at Sunnybrook Health Sciences Centre who specializes in sleep disorders.
Dr. Andrew Lim is an associate professor of neurology at the University of Toronto and a neurologist at Sunnybrook Health Sciences Centre. (Doug Nicholson)
In the long term, people have a higher risk of developing strokes, cognitive impairment and dementia, according to Lim, who is also an associate professor of neurology at the University of Toronto.
Biddiscombe’s own undiagnosed sleep apnea led to mental health concerns, memory challenges, as well as other complications.
“At one point, I remember just sitting on my couch, and I can’t describe it any other way, but it actually felt like my internal organs were rotting because I was so exhausted,” she said.
How do you diagnose sleep apnea?
Plysomnography is the “gold standard” for diagnosing sleep apnea, according to Pendharkar.
“This is an in-laboratory, overnight sleep study where the patient goes into the lab,” he said. “They’re hooked up to a whole bunch of different pieces of equipment.”
Machinery measures brainwaves, muscle activity, breathing and oxygen levels, among other metrics, while microphones also record the sounds that patients make during sleep.
However, in-lab testing isn’t accessible everywhere.
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Back in 2005, Canadians averaged about eight hours of sleep a night. By 2013, that dropped to seven. Now about 40 per cent of Canadians are dealing with some kind of sleep disorder. Something about sleep keeps our bodies and minds from falling apart. The lack of it has been linked to obesity, heart disease, stroke, diabetes and depression. Researchers are now discovering some fascinating things about how important sleep is to the way our brains store memories and learn things.
“In some parts of Canada and actually other parts of the world, there are challenges for people to actually get access to a lab because there just aren’t enough lab resources,” Pendharkar said.
“And so over the last 20 or 30 years, there’s been this emergence of what we call home sleep apnea testing.”
Biddiscombe, who lives in Sherwood Park, Alta., wasn’t offered an in-lab test. Instead, she relied on a take-home test.
“It’s quite a gizmo,” she said. “You have to tape this mask to your face, you have a microphone attached to your neck, you’ve got a [pulse oximeter] attached to you for oxygen levels … you have tape everywhere and then you’re supposed to sleep.”
Pendharkar says experts are looking for reductions in overall airflow, dips in oxygen, changes in blood oxygen, as well as snoring.
“That’s the same whether you’re doing the home test or the laboratory test,” he said.
After her at-home sleep study confirmed her sleep apnea diagnosis, Biddiscombe purchased a CPAP machine for roughly $2,400 to aid her breathing during sleep.
Pendharkar says CPAP machines are the “first-line, gold standard” treatments for sleep apnea.
“Essentially what that is is a little box that sits on the bedside table, connected to tubing, connected to a mask that fits either over the nose or over the mouth and nose,” he said. “The box blows pressurized air through the mask and essentially blows air into the airway to hold it open, to prevent it from collapsing.”
CPAP users can adjust the amount of pressure to the amount required to hold open their airways.
Some people living with mild to moderate sleep apnea can also benefit from a mandibular advancement device — a kind of dental appliance that pulls the lower jaw forward to improve breathing.
“Those are actually very good treatments for reducing not only the number of these respiratory events that are happening, but also improving sleepiness and quality of life,” said Pendharkar
Pendharkar acknowledges that some patients have a hard time adjusting to sleeping with a CPAP mask.
Biddiscombe started off with a mask that covered her nose, which quickly proved uncomfortable.
“My nose was so sore, it wasn’t even funny,” she said. “I spent the entire day making sure it was constantly covered with Vaseline. It was horrible.”
Despite the discomfort, however, her CPAP machine worked.
“I was actually able to finally sleep,” Biddiscombe said.
Pendharkar recommends consulting with a health-care professional before purchasing a CPAP machine.
Pendharkar has researched the cost of sleep apnea treatment across Canada. Ontario, Saskatchewan and Manitoba are currently the only provinces that fund CPAP treatments through government programs, he said.
“Everywhere else in the country, there are programs for people who have very low incomes, but otherwise people are paying out of pocket through private insurance,” he said.
“Which is too bad, because I think that really limits access.”
Biddiscombe hopes that additional regulation can equalize the cost of CPAP machines — across the country.
“I don’t understand why somebody in Ontario can buy the exact same machine as me for $800, and I’m in Alberta paying $2,400,” she said.
A continuous positive airway pressure machine, also known as a CPAP machine, is considered the gold standard treatment for sleep apnea. (Jean Delisle/CBC)
“I think it’s just life and work and other stressors that come in your life when you’re at the age I’m at,” she said.
Since getting diagnoses and beginning to use a CPAP machine, however, she says she’s had a noticeable improvement in her health and wellness.
“I have more energy, I have more cognitive abilities than what I had before, I can actually concentrate,” she said.
She hopes women – especially those experiencing perimenopause – learn from her overall experiences navigating the medical system.
Skinstitut Holiday Gift Kits take the stress out of gifting
Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.
In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.
“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.
There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.
Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.
Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.
In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.
Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?
It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.
Here’s how you can prepare your digital life for your survivors:
Apple
The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.
For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.
You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.
Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.
Google
Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.
When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.
You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.
There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.
Facebook and Instagram
Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.
When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.
The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.
You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.
TikTok
The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.
Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.
X
It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.
Passwords
Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?
Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.
But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.
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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.
The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.
New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.
The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.
Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.
Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.
“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.
“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”
McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.
But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.
The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.
He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.
“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.
“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.
McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”
McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.
He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.
“Early identification of reading difficulty can truly change the trajectory of a child’s life.”
This report by The Canadian Press was first published Oct. 23, 2024.
