Millions of people in Canada have sleep apnea. The problem is not all of them realize it | Canada News Media
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Millions of people in Canada have sleep apnea. The problem is not all of them realize it

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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.”

The dangerous sleep disorder that goes undiagnosed for many Canadians | In-Depth

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

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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.

Testing costs vary depending on whether the study is conducted in-lab or at-home. Full, in-lab sleep studies are covered by several provincial health-care plans, but home tests are sometimes paid by patients out of pocket. In Biddiscombe’s case, her take-home test was free.

How can you treat sleep apnea?

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.

It’s also worth noting that both the U.S. Food and Drug Administration and Health Canada have been informed of a recall of certain models of Philips CPAP machines due to health risks.

Equal sleep apnea treatment remains out of reach

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.

Even with the device, she says she still doesn’t sleep the full seven to nine hours recommended by physicians.

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.

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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