newsminer.com

FAIRBANKS — In recent months, Don “Standing Bear” Forest has become a new man.

So says his wife, Edie.

“When people ask how Don is doing, I say, ‘He’s getting younger every day,’” she said, and only half joking.

Edie told stories of the old Don, who fell asleep in his chair at 4 in the afternoon, had little to no energy to put into chores, activities or conversation — he would even fall asleep while talking, she said — and who slept in his recliner because his snoring kept her awake.

“When we went on vacations we had to sleep together. It was awful,” Edie said.

But all that has changed, thanks to a local medical service and, Don said, “great people” and modern technology at the Sleep Clinic at Fairbanks Memorial Hospital.

In January, Don was fitted with a breathing apparatus known as a continuos positive airway pressure machine, or CPAP. His diagnosis, he learned after visits to the sleep clinic, was Obstructive Sleep Apnea, a condition clinic medical director Dr. Owen Hanley said is more common than people think.

“About 90 percent of people with sleep apnea don’t know they have it until they get it checked,” Hanley said. “Usually the people themselves don’t know what is going on, but the spouse or sleeping partner does.”

The spouse is aware of the problem because apnea often causes snoring or, in more serious cases, interruptions in breathing during sleep. According to the American Academy of Sleep Medicine, some narrowing of the throat occurs for everyone during sleep because the muscles relax, but it causes no problems under normal conditions. For others — those with obstructive sleep apnea syndrome, or OSAS — the breathing passage narrows to the extent that breathing becomes difficult, likened to “breathing through a floppy, wet straw” by AASM. This causes snoring, which often alerts someone sleeping next to a person with OSAS, but it is more than that, Hanley said, noting the resulting lack of oxygen in the body can cause major health concerns.

“When this happens, the person simply can’t breath. It causes adrenaline rushes, which increases blood pressure, which causes more congestive heart failure. It causes swelling of legs, kidney malfunctions, headaches and blood sugar problems. It can cause heart irregularities due to the lack of oxygen,” Hanley said, even adding impotency and menstrual problems to the list of consequences.

Don and Edie are not alone in their story of fitful sleeping, lack of energy and severe snoring. Hanley said a large majority of his patients, often men, come in complaining about their spouse’s complaining of a problem. The patient often admits to feeling tired — Hanley said it is common for a patient to claim, “No matter how much sleep, I get I don’t feel rested.” — but doesn’t think there is a larger problem; they are there to quell spouses’ grumbles. Often, he said, the patient will give an explanation of what is going on, while the spouse gives a negative head-shake.

“We tell them we tend to believe the one who was awake at the time,” Hanley said.

Edie can relate. She was aware of her husband’s restless sleeping, but Don didn’t believe he had a problem. His general care doctor knew of his other health concerns, such as high blood pressure and other risky elements that tend to go hand-in-hand with sleeping problems. She also knew of Don’s other complaints of fatigue — “I told her I didn’t remember ever dreaming,” he said, a problem indicative to sleep abnormalities. His doctor told him to visit the sleep clinic.

“I had been telling him that for quite a while, but who listens to their wife?” Edie joked.

So Don relented to a sleep study at the clinic, and the results surprised him much more than they surprised his wife.

“The first time I did the study, they looked at the results and said they had to do it again because the numbers were so extreme,” Don recalled. “The second time they were the same, and I was diagnosed with Acute Severe Obstructive Sleep Apnea.”

Don learned why he would so often wake up “sucking wind,” as he called it, gasping for breath. His breathing passage was obstructed during sleep. He was not getting the REM sleep, or Rapid Eye Movement sleep, considered to be the deep state of sleep necessary for good health, because his lack of oxygen was preventing adequate resting conditions.

Causes and cures

Sleep problems in general can have a variety of causes. Hanley said practicing proper “sleep hygiene” is the best way to overcome many problems without turning to a medical professional.

“It is when people are doing everything right, like reserving eight hours for sleep and not drinking five cups of coffee at night, and are still having problems sleeping that we become concerned,” he said. “Often people just need to learn how to sleep again.”

While many sleep difficulties are related to breathing obstruction, the causes of the obstruction can vary. According to the American Academy of Sleep Medicine, contributing factors include a smaller-than-normal jaw, large tongue, enlarged tonsils or tissues that partially block the breathing passage. Some of these problems, such as nostril or jaw problems, can be corrected with surgery. Others are often treated with the positive airway pressure systems. These systems provide the right amount of pressurized air needed to prevent the collapse or obstruction of the airway. Hanley said the devices are prescribed, and successful, for around 90 percent of patients complaining of sleep problems.

There are various types of airway devices. There are masks, which strap around the head and connect to an oxygen machine, and there are smaller breathing tubes that can be inserted into the nose and cover less of the face. The machines have a high rate of success.

“We tell people they will be changed after just one night, one good night’s sleep,” said Kathy Kurkowski, supervisor of Fairbanks Memorial’s sleep department. “Some people won’t go anywhere without their CPAP machines.”

There are also steps individuals can take on their own. Because obstructive sleep apnea syndrome is often related to weight issues, losing weight is key, Hanley said. Also avoiding alcohol within four hours of bed time — alcohol depresses breathing and makes episodes more frequent and severe — can help, as can avoidance of sleeping pills, which have a similar effect. The American Academy of Sleep Medicine also warns that medications should be taken with care, as those prescribed for headaches, anxiety and other common problems can affect sleep and breathing. Sleeping on the side or stomach is better than the back, and relief of nasal stuffiness, either with medications or nasal dilators, can also help.

The process

Kurkowski and Hanley said getting started requires an acceptance of the problem as well as education. There are sleeping issues that can’t be treated with breathing devices, such as general insomnia, and education about sleep hygiene — maintaining an internal sleep clock by going to bed and rising on a regular schedule and avoiding things like caffeine and alcohol before bed — are things a person can do without medical assistance. For patients who do visit the clinic, Hanley starts by getting their story.

“Dr. Hanley will spend time with the patient and talk them through their history to get a feel for their questions and situation,” Kurkowski explained. “Then, if he feels testing is necessary, they are scheduled within the next week for an overnight sleep study.”

Patients like Don then spend a night in one of the hotel-like rooms at the clinic, connected to sensors that monitor breathing, brain waves, heart rate, oxygen levels and movement throughout the night. The results can vary and can be astonishing for some deemed “severe” cases.

“If you knew you were waking up 120 times an hour, you would understand why you are tired,” Hanley said.

Kurkowsi said waking up anywhere from 10 times an hour and up is considered an abnormal sleeping pattern, but the level of severity often depends on the patient’s perception.

“For some, up to 30 times (of waking up) is moderate, and up to 50 is severe, but if a person wakes up 20 or so times and doesn’t feel affected, they wouldn’t be considered problematic,” she said. “It really depends on the amount of oxygen lost and the affect of that.”

Hanley says the damage caused by such disruption is “systemic.”

“It affects everything in the body because everything needs oxygen,” he said.

Once the sleep study is complete, Hanley and Kurkowski know how to treat it: often with a positive airway pressure system, or PAP; sometimes with surgery; and other times with suggestions such as weight loss. Hanley said his favorite part of the job is the rave remarks from patients when they return for their first check-up after using a PAP.

“At that two-week follow up they say, ‘My life is totally different,’ and they have stories about doing sports again, being more active and just feeling like a different person,” he said. “Those appointments make my day.”

The risks and the challenges

Sleep treatment is not always a quick skip to good Z’s. While now overwhelmingly satisfied, Don’s treatment was not an overnight cure. His first trip to the sleep clinic was in 2001, and even though he then learned of his problem, he had trouble sticking with the treatment plan.

“I have claustrophobic tendencies, so I would tear the mask off at night or wake up unnerved,” he said of his first PAP, which was a larger mask that covered most of his face. “It was very uncomfortable.”

He used the machine on and off for about a year, he said, then put it in the closet. The initial improvements had been minimal, Edie said, and he was back to his old, sleepy self when the PAP went into the closet. Again his doctor warned him of high blood pressure. Last fall Don returned to the clinic for another study, with some chagrin.

“I think for many men, myself included, it is a prideful issue. You don’t want to be hooked to a machine for the rest of your life or feel weak,” he said of his initial doubts.

Don said he now knows those concerns are unwarranted — “No one sees you but your family,” he said — but at the time he needed some coercing. A comment from a fellow patient helped: The man was close to Don’s age and told him of heart problems he had suffered. “If I would’ve done this years ago I wouldn’t have needed heart surgery,” Don recalls the man saying.

Technicians on staff at the clinic also offered support. Don said one tech sat him down and gave him the news straight.

“He knew I had been there before and knew what my troubles were. He said, ‘Don, you need to do something because I know you want to spend more time with your beautiful wife.’

“He saved my life,” Don said.

Don and patients like him face a number of risks by resisting treatment. Hanley said while excessive fatigue is the key factor involved, the repercussions of that are very serious.

“We get a lot of truckers in here, and that becomes an occupational hazard,” he said. “It is also just dangerous. We see a lot of people that are involved in accidents because they fell asleep at the wheel.”

Untreated, obstructive sleep apnea syndrome causes headaches and nausea and causes people to lose concentration or to become forgetful, irritable, anxious or depressed. It also can lead to high blood pressure, heart attack and stroke risks.

The results

Don’s concerns about the full-face mask were addressed after his second sleep study. He was first fitted with another, smaller mask, but eventually ended up with a device called nose pillows, which slip into the nostrils and are connected to a head mask and an oxygen machine. That was in January, and life has since improved—for him and for Edie.

“He’s a different man,” Edie said with a smile, sharing stories of his new-found energy for lawn mowing, even as late as 9 p.m. In the past she struggled to wake him for dinner.

“I don’t take naps anymore,” Don said proudly.

Having more time together for talking, activities and vacations has helped them grow closer. So has being able to sleep comfortably in the same bed instead of separate rooms.

“We’ve been married 21 years and it is getting better every day,” Don said.

Don’s career as an artist has seen as many benefits as his marriage, he said. The lack of oxygen and sleep was making him groggy, unable to concentrate, and his mental function was not, he said, conducive to creativity. But it is lost no more. He has poured himself into his art since January and earned third place in the National American Indian Art show in April. He said without the additional sleep, he wouldn’t have been able to make the elaborate hand-woven belt. His touring schedule has also grown in scope, with nine shows planned across the country in the next year. Last year he did only three shows.

“His wife goes with sometimes, but the CPAP goes all the time,” Edie said, still smiling.

Standing Bear may not be changing his name to Sleeping Bear, but he certainly has plenty of praise for his new-found rest.

“My blood pressure is down, my energy level is up, I’m sharper,” he said. “It has changed my life.”

Contact Features Editor Erica Goff at 459-7523.