Sleep apnea a growing and costly concern

Ever heard of the fabled "choking ghost" that prevents a good night’s sleep?

The mysterious — and often unnerving — occurrence may be caused by sleep apnea, a potentially severe disorder in which a person’s breathing is disrupted throughout the night.

Sleep apnea is a growing problem in Hawaii with high costs from related health complications, lost productivity and increased accidents.

Kaiser Permanente Hawaii’s sleep lab at the Moana­lua Medical Center has seen triple the number of patients over the past five years, said Shanon Taka­oka, medical director. The lab completed about 1,500 sleep studies in 2012, up from 1,000 in 2011.

"It’s been growing exponentially," she said. "It’s an issue that’s far-reaching. It is something that we really do take for granted until something goes wrong. Health-related complications don’t occur until after many years of poor sleep, making it even more difficult to take sleep complaints seriously."

The most common type of disorder, obstructive sleep apnea, afflicts at least 20 million Americans — more than asthma or diabetes — and that doesn’t include millions more sufferers who are undiagnosed, according to the American Sleep Apnea Association.

The group estimates the total economic cost of sleep apnea nationally at between $65 billion and $165 billion, greater than asthma, heart failure, stroke and hypertension.

What’s more, people with sleep apnea tend to have high blood pressure, heart problems, stroke, depression and sexual dysfunction, resulting in annual health care costs two times greater than those without the condition, the association said.

Sleep apnea, collapse of the upper airway causing abnormal breathing and oxygen levels, is one of the most common sleep disorders next to insomnia, the inability to fall or stay asleep. The Centers for Disease Control and Prevention recommends adults get seven to nine hours of slumber a night.

Sleep apnea is associated with critical conditions including stroke, heart attack and even death as it stifles oxygen to the heart and brain.

It has become an epidemic in Hawaii, said Dr. Ira Zunin, medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center, which invested $100,000 to open the Nio­lo­pua Sleep Wellness Center last month in the Hono­lulu Club building on Ward Avenue.

(Zunin is a contributor to the Star-Advertiser whose column, "Wealth of Health," runs Saturdays.)

"What we’re seeing is this epidemic for sleep apnea that’s not been addressed. Sleep apnea is extremely common, and it’s not on top of mind for most primary care physicians," he said. "Sleep apnea is sleep deprivation. Even though you think you knock out for the night, you’re not getting restorative sleep. It’s a form of torture for the body."

A 2011 CDC survey said Hawaii was the most sleep-deprived state in the nation, with about 45 percent of residents surveyed reporting less than seven hours of sleep a night and nearly as many falling asleep unintentionally.

"An estimated 90 percent of people with sleep apnea do not know they have it," said Christine Fukui, medical director of a sleep lab within the Nio­lo­pua Sleep Wellness Center. "Its prevalence is similar to asthma and diabetes. The idea is to try to diagnose it early before you develop hypertension, heart disease. The latest condition to be associated with sleep apnea is cancer."

Nearly half of patients with diabetes suffer from sleep apnea, and more than 75 percent of patients who are obese or have congestive heart failure also have the disorder, according to the center. Severe sleep apnea increases the risk of death by nearly 50 percent.

While the typical sleep apnea patient is an overweight male, certain ethnic groups, including Asians, Polynesians and African-Americans, are more inclined to develop the condition due to their facial structure, Fukui added.

"If we can manage sleep apnea, we can be saving costs on heart attacks, strokes, kidney failure and motor vehicle accidents," Zunin said. "It’s a big safety and productivity issue in the workplace."

Judy Wilks, a 64-year-old Manakai o Malama patient who has lived with sleep deprivation for the past decade, finally decided to address the problem, which has grown to affect her driving. She completed a sleep study at the new sleep lab Thursday.

"It didn’t become an urgency until the last five or six years because of the complications it gave me when I was driving," she said. "When I come to a stoplight, especially if it’s a hot day, I have to really keep myself from dozing off. If I sit idle too long, it causes me to be very drowsy. I can be in a parking lot of a supermarket waiting for the kids to get groceries and kind of doze off."

Increasingly busy work and home schedules make sleep a low priority, and people often compensate by sleeping in on weekends, taking naps or drinking caffeinated beverages, according to Kaiser.

"People think it’s just the norm. All of us think it’s not a big deal," Wilks said of the condition that has made her fatigued, irritable and impaired her thinking. "You just kind of live with the situation. I really want to be able to sleep comfortable, get up refreshed. I’m excited to actually go to sleep, wake up and just have a life."