Imagine someone pressing a pillow over your face while you sleep. You wake up and struggle for air. After 10 seconds, you're allowed to breathe again. But pretty soon, the pillow goes back over your face.

That's essentially what's happening if you have obstructive sleep apnea (OSA). Your airway gets blocked, perhaps by your tongue or your throat muscles relaxing too much. You wake up a little as you struggle to breathe again. This could happen hundreds of times a night.

The stress of struggling for air throughout the night is bad for your blood pressure and hard on your heart. You're not getting enough sleep, so you're tired and irritable during the day. You might fall asleep at work or while driving.

We could talk statistics and risk factors. For example, one study of men with type 2 diabetes showed that 23% had OSA.

But sleep apnea is not a silent disease. So the question to ask yourself is not: "Do I fit the profile?" but rather "Do I have symptoms of sleep apnea?"

Top Signs of Sleep Apnea

You snore. Often and loudly.

If your spouse has moved into the guest room or your landlord says the people in the next apartment are complaining, that's a big red flag.

Someone has seen you stop breathing for a few seconds or gasp while you're asleep.

It doesn't get much clearer than this.

You're sleepy during the day.

Joe Carnevale, a machinist in Philadelphia, didn't realize that his daytime sleepiness was from sleep apnea. "I just chalked it up to the diabetes," he says. High blood glucose levels can make you tired, but Carnevale's blood glucose levels were not that high. His endocrinologist, Arvind Cavale, MD, suspected sleep apnea. Carnevale snores so loudly that his wife wears earplugs. He caused a three-car accident on his way to work one morning when he fell asleep at the wheel and turned into oncoming traffic. Another time he fell asleep at a red light, his foot slipped off the brake, and he tapped the car ahead of him. Carnevale just got the results from his sleep study: severe obstructive sleep apnea.

Other signs that could mean you have sleep apnea:

• You often wake up with a headache.
• You have a sore throat in the morning.
• You get up during the night to go to the bathroom.
• You have trouble concentrating during the day.
• You're depressed.
• You have high blood pressure.

At Alamo Diabetes Team, a diabetes education service in San Antonio, each patient is asked three questions: "Do you snore? Do you wake up tired? Are you being treated for high blood pressure?" Those who answer yes to any of the three questions are asked more questions to assess their risk. Over half of patients score at high risk for sleep apnea, and their doctors get letters that recommend testing them for sleep apnea. Virginia Zamudio Lange, RN, MSN, CDE, says that screening people with diabetes for sleep apnea should be routine. "It is unacceptable not to screen, given the frequency of sleep apnea and the proven benefits of treatment," says Lange.

Sleep Apnea and Diabetes

Some studies suggest that sleep apnea may worsen insulin resistance. And you can see how sleep apnea may interfere with diabetes treatment. You're dead tired at work, so you keep yourself awake with muffins and coffee. When you get home, all you have the energy to do is sit in front of the television.

Will treating sleep apnea improve blood glucose levels? Researchers in Australia and Minnesota (other research sites may be added in September) are recruiting people with type 2 diabetes and obstructive sleep apnea for the GLYCOSA Study. They will treat half the participants for sleep apnea and see whether they have better blood glucose control than the people who are not treated for OSA.

Whether it helps with blood glucose control or not, treating sleep apnea will improve your quality of life, and it will lower your blood pressure, which lowers your risk of heart attack and stroke.

Diagnosis

If you have signs and symptoms of sleep apnea, your doctor may order in-home monitoring. If this shows that you are suffering from sleep apnea, you can move right to treatment.

If in-home monitoring doesn't show that you have sleep apnea, your doctor may order an overnight sleep study, which is more sensitive, more expensive, and may not be available in your town. You'll spend the night at a sleep center, hooked up to sensors that detect how well you're sleeping and whether you're getting enough oxygen. Make sure that you jump through all the insurance hoops before you do the sleep study. Your plan may require that you go to a certain sleep center.

Treatments

• CPAP
  If you have moderate to severe sleep apnea, you may be prescribed continuous positive airway pressure (CPAP, pronounced "C-pap"). You wear a mask over your mouth and/or nose at night, and a machine gently blows air through the mask. The air pressure is adjusted to be just enough to keep your airway open.
• Dental Device (a.k.a. oral appliance, intraoral device, or mouthpiece)
  Breathe through your nose. Now move your lower jaw forward. Does the back of your throat feel a bit more open, making it a little easier to breathe? A dentist or orthodontist can custom make a device for you to wear at night that will keep your lower jaw and/or tongue forward. See photos of different types here. If you grind your teeth at night, ask the dentist if that affects which devices you can consider.

You may want to hear about the experiences of others with this or that device or treatment. You can go to a support group or do an Internet search to find forums on the device you're considering. For example, one entry on www.cpaptalk.com lists the four stages of CPAP adjustment as "intolerable, uncomfortable, tolerable, comfortable." If you know this going in, you'll know not to give up too early.

Home Remedies

Getting diagnosed and finding the right treatment takes time. Starting today, you can try some home remedies that may help:

• Don't drink alcohol or take sedatives or sleeping pills.
  These may let your throat close up more. Until you get treatment that eliminates the apnea episodes, you don't want to be drugged at night because you may wake up more slowly during an episode of apnea.
• Lose some excess weight.
  After Joe Carnevale lost 15 pounds last year, his wife noticed that his snoring got better. But when he regained the weight, his snoring came back full force.
• Keep yourself from sleeping on your back.
  Sew a pocket on the back of your pajama top and put a tennis ball in it. Or fill a backpack with foam rubber and wear that at night.
• Treat nasal congestion.
  Try using a neti pot to rinse out your sinuses with warm salt water. You can get a neti pot for less than $20 at your local natural foods store and some mainstream drugstores.

Resources

American Sleep Apnea Association

American Academy of Dental Sleep Medicine

Information in Spanish from the National Heart Lung and Blood Institute

Marie McCarren is a medical writer who has specialized in diabetes for 15 years. Her books include ADA Guide to Insulin & Type 2 Diabetes and A Field Guide to Type 2 Diabetes.