Memory loss—or sleep apnea?
The woman in her early 60s—let’s call her Lydia—had lately been forgetting the simplest things: where she placed her car keys, what errands she was planning to run, a telephone message from her husband at work.
She found herself having to write down a virtual script for the day, lest she stand up a friend for lunch or forget to put the roast in the oven for dinner.
In addition to feeling disorientated, Lydia also was feeling increasingly depressed and lethargic. Her family worried that she might be suffering from early onset Alzheimer’s disease.
When Lydia finally went to her primary care physician, he noticed that her blood pressure was higher than during a previous visit. She complained of not sleeping well at night. In fact, her snoring had become so loud that her husband had moved into a separate bedroom.
Lydia’s doctor began to consider the possibility that her forgetfulness was not a sign of dementia at all, but rather sleep apnea.
Lydia was referred to Mir F. Shuttari, MD, a pulmonary expert and sleep specialist at Falmouth Hospital, who directs the hospital’s Sleep Lab. He immediately ordered a test to measure the oxygen saturation in her blood.
Red blood cells carry oxygen through the arteries to all internal organs. Normally, when red blood cells pass through the lungs, 95 percent to 100 percent of them are loaded, or “saturated,” with oxygen. If you have lung disease or other types of medical conditions, fewer of your red blood cells may be carrying their usual load of oxygen.
That can lead to the symptoms Lydia was experiencing. Indeed, her reading was abnormally low, and that led Dr. Shuttari to immediately schedule an overnight sleep study.
Soon, Lydia was in a private room at the Sleep Lab, ready for a night’s observation. The key to analyzing her situation would largely be guided by a test called the Apnea Hypopnea Index, or AHI. It recorded the number of Lydia’s apneas or hypopneas per hour of sleep. Fewer than five events per hour is considered minimal. Five to 15 is considered mild; 15 to 30 is moderate and more than 40 per hour is severe.
“When we conducted the AHI,” her numbers were very high, some 32 obstructions per hour,” said Dr. Shuttari. “Her oxygen levels during the events would drop to 78 percent.”
Before the evening’s observation was even half over, Dr. Shuttari and his team knew what to do next. They fitted Lydia with a machine known by its initials CPAP, or continuous positive airway pressure. The machine uses mild air pressure to keep the airways open.
In obstructive apnea, the airway collapses or is blocked during sleep. When apnea sufferers breathe, air that squeezes past the blockage can cause loud snoring—loud enough to chase Lydia’s husband out of their bedroom.
The doctors fit a strapped mask over Lydia’s nose and mouth. The machine—small, lightweight and fairly quiet—blew air through a tube into the mask.
Once hooked up to the CPAP machine, Lydia quickly fell into a deep sleep. When she awoke in the morning, her first question to the nurses was: “Is this how you are supposed to feel?”
“She told me she hadn’t felt that alert in decades,” Dr. Shuttari recounted.
Lydia will rely on the CPAP for the rest of her life. But, if she is diligent, while also watching her weight and her diet, the prognosis for her sleep apnea is very positive.
Months later, her family accompanied Lydia to Dr. Shuttari’s office for a follow-up. She had regained all her spunk and memory.
“Thank you for getting our mom back,” one of her children said. “We thought we had lost her.”