(April 29, 2010)    Doctor Death, a k a the pathologist and right-to-die activist Dr. Jack Kevorkian, was released on parole in 2007 after serving eight years in a Michigan prison for second-degree murder. In an interview after his release, Dr. Kevorkian said, “The worst thing about being in prison was all the snoring.”

    For many people, snoring is like being in prison — for those who snore and for those who have to listen to it. But snoring is not just darned annoying, it’s downright dangerous.

    Those who snore will also commonly stop breathing during the night. It is called obstructive sleep apnea. The word “apnea” comes from the Greek, meaning “without breath.” As a person relaxes to sleep, the soft tissues in the back of the throat collapse into the airway, blocking airflow.

    An apnea sufferer may stop breathing for as long as 40 seconds, and then the falling levels of oxygen in the blood will wake him up with a loud snort. This cycle can repeat 20 to more than 50 times an hour, putting great stress on the heart, brain, and nervous system.

    Sleep apnea causes and contributes to an enormous amount of illness and early death. It has been associated with causing diabetes, high blood pressure, heart disease, depression, irregular heartbeats, obesity, and stroke. Your quality of life is terrible with sleep apnea. There is an increased risk of automobile accidents, job injuries, and poor work performance. You may have trouble with concentration, memory, personality changes, and anxiety.

    The typical sleep apnea sufferer is an overweight, middle-aged man, but thin young men, women, and children can have it too. The most common cause of apnea in children is enlarged tonsils and adenoids, though skyrocketing rates of obesity are causing more sleep apnea in kids.

    Common symptoms of sleep apnea include snoring, daytime sleepiness, weight gain, low energy, depression, and waking up with a headache or with a dry mouth. A bed partner or family member may observe the apnea sufferer waking up gasping for air during the night.

    According to a December 2008 study of more than 7,000 Georgians sponsored by the Centers for Disease Control and Prevention, 33 percent admitted that they snore, 35 percent said they wake up in the morning unrefreshed, and 16 percent had trouble staying awake during the day.

    The National Sleep Foundation says that 18 million Americans have sleep apnea, but a recent poll by that group found that more than one-third of America’s adults reported that they snored frequently. The problem may be much larger than we think.

    Sleep apnea is definitely related to being overweight. Perhaps the first recorded case of obesity-related apnea was in the fourth century B.C.E. Dionysius of Heraclea was notorious for his appetite and eventually grew so heavy that he could scarcely move. He suffered from severe apnea, prompting his doctors to jab his flesh with needles whenever he fell asleep on the throne. He died at a young age, strangled by his own flesh.

    Charles Dickens wrote about Joe the fat boy in his 1837 novel, “The Posthumous Papers of the Pickwick Club.” Joe was quite obese, could not breathe well as a result, and tended to fall asleep constantly. The medical term Pickwickian syndrome, for breathing difficulty that results from obesity, originates from Dickens’s vivid description of this character.

    If you suspect that you may have sleep apnea, you need to get a medical diagnosis nailed down. Traditionally this testing has been done by staying over in a sleep lab, but now there is accurate home monitoring that is reimbursed by insurance and more realistic for your own sleeping conditions. The testing materials can even be mailed to you.

    Dr. Jordan Stern is a board-certified otolaryngologist and founder of the BlueSleep Apnea Resource Center in Manhattan. He has pioneered home testing and the multimodality treatment of sleep apnea.

    “Remarkably, 80 percent of people with sleep apnea are undiagnosed,” Dr. Stern told me. “Twenty-five percent of men and 10 percent of women over the age of 45 have sleep apnea, and the numbers are increasing with rising rates of obesity. This sleep problem is a major contributor to serious chronic illness in the United States.”

    First-line treatments include weight loss, treatment of a stuffy nose, or a jaw-bite appliance to pull the jaw and tongue forward off the back of the throat. Tennis balls sewn into the back of your pajamas will keep you on your side, but you can still have problems in that position. Don’t bother with the cheap and cheesy bite appliances sold on TV. For the most part they don’t work and can mess up your jaw joint. Nose strips may help some people.

    Surgical remodeling of throat structures that block airflow may be right for certain patients, but the gold-standard treatment is a pressurized breathing machine called a CPAP. It stands for continuous positive airway pressure. You sleep with a mask on your face or nose, and air pressure keeps the airway open all night. For many sleep obstructers, like Rosie O’Donnell, CPAP is a godsend. Blood pressure comes down, depression lifts, and blood sugar levels improve.

    Some people are mean to those who snore, but apnea sufferers can’t help it. They don’t need a poke in the ribs; they need encouragement and support to get help. Consult a sleep apnea specialist who has a variety of treatments to offer — you want an unbiased recommendation.

    Stop waiting breathlessly for something to change — without appropriate intervention, it won’t. Sleep apnea is medically dangerous, and home sleep testing is now really easy. You will like breathing freely at night, and others will appreciate the peace and quiet.

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    Questions can be directed to Dr. James N. Dillard at jdillard@ehstar.com.