Learning to live with a mask

If you're snoring all night and tired all day, you might be one of the estimated 18 million Americans who have obstructive sleep apnea, most of them undiagnosed.

There's a popular treatment that can eliminate breathing interruptions and provide restful sleep.

But there's a problem: A lot of people hate it.

It's called CPAP, for continuous positive airway pressure.

It's basically a mask that looks like part of a hazmat suit. And who wants to wear that all night long?

Aaron Taylor didn't.

"I got the machine. I tried it for a night or and two. It was hard. And I put it in the closet," said Taylor, 39, a CBS sports analyst and former offensive guard for the Green Bay Packers and San Diego Chargers.

Sleep experts say half of sleep apnea patients who are prescribed CPAP machines don't use them, in part because they don't receive enough education and encouragement to be successful. Taylor said he got help from a volunteer "sleep coach" through the free Wake Up To Sleep program, sponsored by a manufacturer of CPAP machines. (See number in box.)

"It took me probably three to four weeks of diligent, consistent work to finally get my mask where I needed it," said Taylor, who is now a sleep coach himself and a paid ambassador for the manufacturer.

Today, he uses his mask every night, even on the road. And his message to other "big macho dudes" is that sleep apnea is serious and can be fatal. It killed former Panthers defensive end Reggie White, who was 43 when he died at his Cornelius home in 2004.

"He died from complications of untreated sleep apnea," said Taylor, who had been White's teammate at Green Bay. "The (CPAP) machine was by his bedside, and it was unused."

Sleep apnea "has killed NFL football players. It was killing me, and it will kill you too if you don't do anything about it," Taylor said.

Taylor, who lives in California, will talk about his struggles with the CPAP machine this week in Charlotte in connection with the Carolina Clinical Sleep Symposium for health care providers.

"It's a constant problem," said Dr. Ambrose Chiang, director of the pulmonary sleep apnea program at Duke University Medical Center, who will also speak. "We have folks who say 'There's no way I'm going to use this. Forget it.' "

Chiang acknowledges the mask can be difficult to wear. But he cautions patients not to give up too quickly.

"There are different things we can do to help," he said. "We have to find out exactly what the problem is. You have to be using the right device. It might take multiple trials. ... It involves a significant lifestyle change and lifelong commitment."

'Snoring is the red flag'

Obstructive sleep apnea is caused by a blockage of the airway, usually when the tongue and soft tissue in the back of the mouth fall back and close off the throat.

The condition appears to develop more often in people who are obese and who sleep on their backs. It is more common among men than women (before menopause). A recent study of football players found that 40 percent had undiagnosed sleep apnea. But Dr. Jeannine Gingras, a specialist at Gingras Sleep Medicine in Charlotte, said she also has many patients who are "young, thin athletic women."

"Snoring is the red flag," Gingras said. But not everyone who snores has sleep apnea. "The thing that brings most people in is daytime sleepiness."

People with sleep apnea wake up feeling unrefreshed because their sleep is interrupted many times, even if they don't actually wake up.

Periods of apnea, when breathing stops, can occur hundreds of times an hour. When that happens, the body senses a decrease in oxygen and releases adrenaline, which alerts the brain and rouses the person enough to start breathing again.

During the process, blood pressure spikes and heart rate increases. Long-term, this can lead to heart rhythm problems, such as atrial fibrillation, and other conditions such as diabetes and stroke.

Seeing a specialist

One of the most common and effective treatments is the CPAP machine, which pressurizes room air and pumps it through a hose and into a mask that fits over a patient's nose. It gently blows air into the throat, artificially holding the airway open, and allowing for more normal breathing during sleep.

Patients who have trouble adjusting may have received too little instruction and follow-up. Problems vary from claustrophobia to sinus congestion.

To get the best help, patients should see board-certified sleep medicine specialists.

Masks are available in many brands and sizes. Some cover the nose and mouth, some just the nose. "Nasal pillows" have two prongs that fit into either nostril and can be more comfortable for people who feel claustrophobic.

Each CPAP device comes with a humidifier, and a setting change may be all that's needed to prevent dry air from causing sinus congestion.

Most insurance plans cover the treatment. Equipment companies may charge more than $2,000 for the machines and accessories, but insurance companies negotiate discounts for reimbursement in the range of $1,100 to $1,800. Deeper discounts can often be arranged for self-pay patients.

Patients with mild sleep apnea who don't want to use CPAP may be helped by wearing a dental appliance that pulls the lower jaw forward slightly, preventing the tongue from blocking the airway.

Obese patients who can't or won't use the CPAP may be referred for bariatric surgery. Losing weight alone can reduce or eliminate sleep apnea.

'He didn't wake up'

Polly C. Pringle and her husband, Bernie, of Charlotte both use CPAP machines. They know better than most people how serious sleep apnea can be. Their 38-year-son, Kevin, died of the condition July 28, 2010.

"My son didn't use his machine because he said it was difficult for him," his mother. "He went to sleep one night and he didn't wake up."

Kevin had just finished a master's degree and started working as a speech therapist in Charlotte. He'd been diagnosed with sleep apnea about two years before.

"Even when you have the most intelligent, educated people, sometimes we can be in denial about our own health," his mother said.

"If he had an idea this was going to take his life, I'm sure he would have tried to sleep with that machine."

Understanding risks

Patients who have better success with CPAP are those who have sought treatment for sleep apnea, instead of being "dragged in by their wives," Chiang said.

He also has patients who accept the treatment because it eliminates snoring and makes life easier for family members. "They say, 'I may have a little problem with this device, but my wife loves it,' " Chiang said.

Patients are more likely to use the therapy if, like the Pringles, they understand the consequences, Gingras said.

One of her patients, Elizabeth Davis, 55, of Charlotte, says she was "tired all day long" before she began using CPAP four months ago. Sometimes when driving in the daytime, she would pull her car over to the side of the road to take a nap.

She didn't like the mask at first, but now she wouldn't give it up.

"It's the best thing that's happened to me," Davis said. "I sleep good all night. I feel 100 percent better."