In the dark of night, a silent intruder approaches the bed, wraps its hands around your neck and squeezes, just enough to stop the breath. Oxygen levels drop, carbon dioxide levels increase, cortisol and adrenaline course through the veins, blood pressure rises and the heart begins to pound. The seconds pass. Just as you are jolted awake, the intruder slips away unseen. Most of the time, we don’t even know it’s happening. We actually only wake up for the big ones and a feeling of anxiety consumes us as we search for a narrative. We worry about the children, job security, paying the bills. After a few minutes, we drift off again and the cycle repeats, usually many times each hour.

Over the past 30 years, I have seen thousands of patients come to clinic complaining of night time waking, non-restorative sleep, daytime fatigue, poor concentration and depressed mood, all symptoms of sleep apnea. Quite often, their bed partners complain that they snore and have long pauses in their breathing while asleep, sometime requiring a shake in order to begin breathing again.

The good news is that every insurance company covers the cost of a sleep study as well as treatment. The combination of snoring and non-restorative sleep alone meets criteria for study approval. The bad news is that, far too often, the gripping problem of sleep apnea is considered neither by patient, bed partner nor provider. Since opening Niolopua Sleep Wellness Center at Manakai years ago, over 90% of the patients we have studied in the lab were positive for easily treatable sleep apnea.

Prior to opening the lab, Manakai had treated tens of thousands of patients struggling with the combination of excessive weight gain, high blood pressure, diabetes and high cholesterol. Over time and with the addition of inactivity, the knees, hips and back begin to go and many come to us having been prescribed medicines for chronic pain or anxiety. Untreated, many suffer from poor function, inability to work, social isolation and reactive depression.

By creating an individualized, integrative plan with our multi-disciplinary team we have observed positive outcomes with solid diagnostics and a combination of dietary changes, medication, physical therapy and psychological and naturopathic services. However, until we opened Niolopua Sleep Wellness Center, there remained a missing link.

Once we added diagnostics and treatment for sleep apnea, we found that many of our patients who were still struggling, gained “lift-off.” Optimism returns, mood improves, depression softens, patients shed excess weight and the need for so many medications begins to fall away.

In the majority of cases, sleep apnea is “obstructive” in nature and caused by excess weight. This is often coupled with “central” sleep apnea related to a reduced drive to breath from medicines taken for pain, anxiety or insomnia. Traumatic brain injury from combat, sports or accidents can also cause central sleep apnea. There are also many patients with normal weight who suffer from sleep apnea that is simply related to the unique anatomy of their head and neck, statistically more common in Asians among others.

The problem is that once sleep apnea develops, it causes or worsens so many of the conditions that then reinforce the apnea itself. The lynch pin is weight gain. While excess pounds are a leading cause of obstructive sleep apnea, the lack of oxygen during frequent long pauses in breathing throughout the night raises cortisol levels which increase appetite and cause fluid retention in the body. Cortisol is a stress hormone. The night time physiological stress, especially when coupled with daytime work and social stress, increases weight, cholesterol, blood sugar and blood pressure. In fact, the combination of sleep apnea and diabetes alone is a major risk factor for heart attack, the leading cause of death in mature adults.

The single most common New Year’s resolution I have heard is the decision to lose weight, but for so many, the solution calls for more than simply a new diet or workout. Certainly, a comprehensive lifestyle plan that includes healthy nutrition and physical activity that is enjoyable and doable are essential, but an annual whole-person exam resulting in a comprehensive care plan typically brings the best chance for longevity and quality of life. Be sure you are safe from that silent night time intruder. Sound, nourishing sleep is the foundation of health.

Ira Zunin, a practicing physician, is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Serv­ices Inc. His column appears the first Saturday of every month. Please submit your questions to info@manakaiomalama.com.