The Ugly, Middle Stepchild

This weekend I found out that my uncle was placed on the heart transplant list. He is the youngest brother of my mother, only about fifteen years older than I am. My mom’s side of the family is pretty big and my grandma was a little older when she had my uncle. I remember growing up as a kid and he would be the one watching us. There was this one time I was being an annoying pain, just wanting to irritate him, shaking my butt in front of the TV, so he couldn’t watch the screen. He got so upset with me that he just kicked me, right in the tush. I must have flew five feet. My cousins were there and they started busting out laughing. I was laughing along with them at first, until my butt started hurting, when I started crying. My uncle’s logic was that if I was going to be a pain in the ass, he would give me a pain in the ass.

He was a healthy guy when he was younger, but over the years, he put on some weight. Still, I was quite surprised when I heard the news. He apparently had a severe case of cardiomyopathy, or an enlarged heart, which can lead to all sorts of complications like heart failure and sudden cardiac death. He started having shortness of breath with the most simple of tasks. When he was finally diagnosed, he was past the point of a quick fix. How did he get the cardiomyopathy? It wasn’t years of drinking or doing drugs or heart valve problems. Wasn’t related to a heart attack or a connective tissue disease. It was related to a long standing history of untreated sleep apnea.

Obstructive sleep apnea is the ugly middle step child of medicine. It never gets any respect. It tends to be ignored until there’s a problem. And it’s a pain in the ass to manage. What is sleep apnea? Sleep apnea is a sleep disorder that typically affects overweight individuals. As a person approaches deep sleep, the body reaches a point of relaxation, where the muscles go limp. In individuals with sleep apnea, the airway collapses due to weight around the neck. Breathing stops. Suddenly, the body starts choking on its own weight and a surge of cortisol is released trying to wake the body up. The individual hopefully wakes, but then usually falls back asleep. The cycle repeats itself into the day, with this potentially happening several times over the course of one evening. 

Over time, the small amounts of cortisol can lead to long standing problems like hypertension and diabetes. In the case of my uncle, pulmonary hypertension developed, where the strain of constantly going into these apneic episodes put an increase in the pressure that his heart had to push against, causing the changes to his heart’s structure, leading to the cardiomyopathy.

The symptoms of sleep apnea can include snoring and daytime sleepiness. More subtle symptoms can include night sweats, dry mouth, irritability and difficulty concentrating. Some patients can even present with depression. While sleep apnea can happen to anyone, typically, the biggest risk for developing it is being overweight. Having a narrow airway or a larger tongue can also contribute along with a deviated septum.

The treatment can involve using a CPAP machine to keep the airway open during sleep. Weight loss, avoiding any nighttime sleep aids like Ambien, and avoiding alcohol at bedtime are also part of the treatment. If the issue is the airway, then surgery can also be part if the treatment.

With sleep apnea, early detection is crucial. But like I said, most people don’t realize they have a problem until it’s too late. Ugly middle stepchild or not, family is family. I haven’t seen my uncle since my wedding, which was almost back 10 years ago, but family is family, and we’re praying for him. Hopefully, he gets his health back in order, but I’ll let his story serve as a warning for those that think snoring is only a  problem for an annoyed spouse to deal with.

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