Sleep apnea underdiagnosed and on the rise, sleep specialists say

And at 27 years old, Mal Parrott was diagnosed with obstructive sleep apnea (OSA). 

It's a medical condition that causes breathing to stop during sleep, and a recurring collapse of the upper airway that causes a drop in oxygen and the brain to wake up. 

It was a shocking diagnosis, Parrott told CBC News. Their father had sleep apnea, but it wasn't really discussed. And it's often associated with older people.

Parrott wasn't seeking a sleep apnea diagnosis at the time. They asked their doctor about getting tested for ADHD. To their surprise, the doctor suggested a sleep test, as well. 

"I've been told by many, many people that I'm a very loud snorer," Parrott said.

"I mentioned it to my fiance and she said, 'Oh yeah, there have been several moments while we are asleep, I will wake up, You are not breathing in your sleep.'"

Armin Rahmani, a sleep medicine specialist with the Canadian Sleep Society, said about 25 per cent of the people in Canada have some severity of sleep apnea. 

Michael Mak, a psychiatrist and sleep medicine specialist at the Centre for Addictions and Mental Health, said approximately 93 per cent of people who are at a high risk of sleep apnea have not been tested. 

On the rise 

Parrott went to the Breathe Well clinic in St. John's to get an at-home sleep test. A week later, they had a diagnosis. 

Sleep apnea is measured through the apnea-hypopnea index (AHI), which counts the number of times a person stops breathing during an hour. Anything over 30 is considered severe. 

Parrott's AHI came in at 36. 

Specialists indicate sleep apnea is on the rise across the country, and among all age groups. 

Mak and Rahmani both told CBC News that rising rates of obesity are contributing to the increasing diagnosis of sleep apnea. Mak said eastern Canada has higher rates of obesity, specifically Newfoundland and Labrador. 

"If that's the case, then you're going to see a greater proportion of people having sleep apnea in your area," he said.

But that's not the case for everyone who is obese, according to Wanda Dollard, a respiratory therapist at the Breathe Well Clinic in St. John's for the last three decades. 

"A lot of times it has to do with the shape of your jaw. If you have a small airway, it could mean that you're a higher risk of apnea," she said. 

"It could be hereditary. So … if your parents have sleep apnea, not that there's a genetic link, but people inherit the same structure of airway." 

Symptoms and treatment

Parrott's symptoms fall in line with what Rahmani describes as typical: snoring, interrupted breathing, chronic daytime sleepiness, never feeling refreshed, difficulty concentrating, dry mouth, headaches and brain fog. 

Sometimes, he said, people can wake up gasping for breath and choking. 

But, the effects of undiagnosed sleep apnea aren't limited to lethargy and day-to-day cognitive difficulty. 

"In the long-term, what we see is that people with untreated sleep apnea have a greater risk of high blood pressure, diabetes, heart attack, stroke, sleepiness, fatigue during the daytime, problems with memory and concentration and depression," Mak said.

"So it affects a lot of, you know, what we have to use on a daily basis and our general health."  

Parrott's day-to-day life — what they considered normal — was along those lines. 

"There would be times where I would just, like, fall asleep wherever I could," they said. 

"Like, if there was a couch, I was sleeping. If there was somewhere that I could sit, I was sleeping. I have come close to falling asleep at my desk at work sometimes." 

Parrott said the brain fog was thick and their attention span was decreased. 

"They said that CPAP therapy would be probably the best option for me," Parrott said. 

CPAP stands for Continuous Positive Airway Pressure. It's a machine with a tube attached to a mask that a person wears while they sleep. The machine pushes pressurized air through the mask and keeps airways open. 

For people with mild sleep apnea, a specialized mouth guard can open the airway. There's also a surgery that can help in some cases.  

But in adults, CPAP therapy is considered the gold standard. 

"That keeps the air going into your lungs and, you know, reduces those risks of those cardiovascular issues," Mak said.

CPAP machines aren't the clunky, loud machines of the early 2000s. They're small, portable, and relatively quiet.

Mak said a lot of people have preconceived notions about wearing the mask and using the machine.

"You're doing so in the privacy of your own home. You're doing it in your own bed," he said. "You're not broadcasting this to everybody and it comes with a tremendous improvement to your quality of life." 

But CPAP therapy does come with a hefty price tag. While some insurance companies cover a partial cost of a CPAP machine, without insurance, one could cost anywhere from $2,000 to $3,000. 

Waking up

Parrott said wearing a mask to sleep was a challenge at first.

"I didn't know how to process it right away until literally I had the CPAP, like, plugged in next to my bed and I was like, well, guess this is my life now," they said.

But they describe the treatment as life-changing. 

"A lot of people in my life often say, like, I'm a new person, essentially, after getting CPAP therapy," Parrott said. 

"It felt like I actually woke up for the first time. Like, I actually had some sleep and then I woke up."

For years, Parrott said they were surviving on extremes. It was either three hours of sleep or 10 hours of sleep. But they never felt refreshed. 

And a month later, Parrott was also diagnosed with ADHD, their original inquiry at the doctor. 

"It was a fun little two-for-one special," they said with a laugh. 

As for using a CPAP machine, they said "it's not something to lose sleep over." 

Download our free CBC News app to sign up for push alerts for CBC Newfoundland and Labrador. Sign up for our daily headlines newsletter here. Click here to visit our landing page.