Refusal To Use CPAP Puts Blacks With Sleep Apnea At Risk

Black people don't like CPAP machines. Actually, nobody does, but black people dislike them more than anybody else. And that's a real problem, because blacks are the group that need them the most.

CPAP (Continuous Positive Airway Pressure) therapy is the most widely used treatment for obstructive sleep apnea (OSA), a very serious medical condition that causes a person to stop breathing in their sleep. It occurs when throat muscles relax during sleep, allowing soft tissue in the throat to collapse and block the passage of air.

Those blockages can cause a person suffering from sleep apnea to briefly awaken, gasping for air, perhaps hundreds of times during the night. That, in turn, can result in a critically low level of oxygen in the blood. In addition, the repeated awakenings throughout the night cause a diminished quantity and quality of sleep that greatly increases an apnea sufferer's susceptibility to health risks such as cardiovascular disease, diabetes, and stroke, not to mention possibly falling asleep at the wheel.

African Americans suffer from OSA more than any other group. One researcher, Elizabeth Beothy of the University of Pennsylvania, found that sleep apnea in black women occurs at nearly double the rate of white women. Another study, conducted at the University of California, San Diego, found that 17 percent of African American test subjects were diagnosed with obstructive sleep apnea, compared to 8 percent of whites.

These statistics indicate that African Americans are at significantly greater risk of early death due to OSA because, according to the American Academy of Sleep Medicine, the mortality rate of people with severe sleep apnea is three times that of those without the condition.

The danger sleep apnea can pose when it is left untreated is illustrated by pro football superstar and NFL Hall of Famer Reggie White. On Christmas day in 2004 Reggie seemed in excellent health, except for a chronic cough. He went to bed that night as usual. But as he slept, his breathing stopped, and he never awoke. The medical examiner concluded that a major contributing factor to Reggie’s death was his sleep apnea condition that had been revealed by a sleep study but never effectively treated.

[See NFL Star Reggie White: Death Due to Obstructive Sleep Apnea].

There are two major symptoms that point to sleep apnea. The first is excessive sleepiness during the day. This is the most important indicator of a possible sleep apnea condition because you yourself will be well aware if this is an issue for you. According to the American College of Physicians, people who don't experience frequent daytime sleepiness don't need to have a sleep study done.

The second symptom is loud snoring, along with multiple instances of interrupted breathing, at night. Significantly, people who have sleep apnea usually will not remember, and may not believe when told, that they snored and briefly awoke many times during the night.

A third symptom that often occurs is waking up with a headache in the morning because of low levels of oxygen in the blood due to the continual interruptions in breathing during the night.

I know from personal experience how bad nights can be for a sleep apnea sufferer. My extremely loud snoring threatened to drive my wife up the wall, or at least into another bedroom. Constantly waking up through the night, gasping for air, left me so sleep deprived I found it almost impossible not to frequently doze off at my desk at work. And the physical discomfort caused by lack of sufficient oxygen through the night made me almost dread going to bed.

When my wife first told me about my loud snoring and gasping, I didn't really believe her. And although it was clear I wasn't sleeping well, I had no idea that I was repeatedly briefly waking up and going back to sleep dozens of time every night.

For a long time I resisted having a sleep study done because I was convinced I didn't really have a problem. When, with my wife's fervent encouragement, I finally broke down and got the test, I was flabbergasted to learn that I indeed exhibited all the classic symptoms of OSA.

Getting that sleep test was one of the best decisions I ever made.

The result of my sleep study was a strong recommendation from the doctor that I begin using a CPAP machine every night.

CPAP is considered the most effective treatment for sleep apnea. The machines restore an apnea sufferer's air flow by injecting positive air pressure into the throat through a mask, forcing the blocked passages to open.

When I started using a CPAP machine, the difference it made was amazing. All my breathing distress went away, the snoring stopped, and my wife and I could once again coexist in the same bedroom.

Although blacks comprise the ethnic group most likely to suffer from sleep apnea, research shows that African Americans are the population least likely to use a CPAP machine. One study concluded that the strongest predictor that a sleep apnea patient would not continue to use a CPAP machine, even after they acquired one, was simply that the patient was black. Usually people try the machine for a few days, then put it aside.

As a CPAP user myself, I think I have some insight into why so many people, especially African Americans, refuse to use a device that could literally save their lives.

The CPAP system, consisting of an air pressure machine, a mask and a hose, is not the most comfortable device in the world. As potential users begin the process of trying sleep with a CPAP mask on their face and the machine humming beside their bed, most will be asking themselves a critical question: is the gain really worth the pain?

It's not that use of a CPAP is physically painful - it's not. But it certainly can be a pain. It takes time, effort and dedication to get used to having something on your face (or perhaps in your nose) as you sleep.

Researchers have found that it normally takes between 30 and 90 days to adjust to using the machine.

In the beginning I had a very rough time trying to adjust the mask so that the pressurized air wouldn't seep out from it and flow into my eyes, something that quickly becomes unbearable. I had to work out, by trial and error, how to lay my head on the pillow for greatest comfort and least air leakage. But the effects of my sleep apnea, my loud snoring along with headaches every night, and the inability to stay awake during the day, had made both me and my wife so miserable, I kept at it.

It took me some time and not a few frustrating nights to get to the point where I could enjoy the benefits of my CPAP rather than struggling with how to live with it. But over time I was able to make that adjustment.

I have been using the machine for more than a decade now, and nothing could make me give it up. I can't conceive of any inducement that would cause me to willingly go back to the days of gasping for air in the night, and nodding off to sleep in the day. My quality of life is indescribably better.

Is the gain from using a CPAP machine really worth the pain? To me, the answer is emphatically "yes."

For more information on being tested for sleep apnea, please see
What It’s Like To Have A Sleep Study To Test For Sleep Apnea