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.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
