Nov. 2, 2009 -- It's hard to convince people that strapping on a contraption at night that looks like scuba gear will help them feel rested the next day, but sleep experts hope that an estimated 12 million people who suffer from sleep apnea in this country will do just that.
Despite research showing that a CPAP device -- short for continuous positive airway pressure -- helps people think better, drive better and perform better on cognitive tests, doctors still report that patients can't or won't tolerate the masks 20 percent to 60 percent of the time.
At least, that is, until some learn it helps their golf game, according to a small study of 24 golfers in which 12 were treated for sleep apnea with CPAP and 12 were not.
Doctors at the Morristown Memorial Hospital in New Jersey found treating sleep apnea in 12 golfers actually improved their game by up to three strokes off their handicap in 20 rounds of golf when they underwent the sleep apnea therapy, according to a presentation today at the annual meeting of the American College of Chest Physicians.
The treatment was a boon for compliance too. The men who were treated for sleep apnea in the golf study stuck with the CPAP treatment 90 percent of the time. The CPAP device gently blows air down one's windpipe while one sleeps.
Sleep apnea is a sleep disorder in which a person's airways become obstructed in deep sleep until they lose enough oxygen that they wake up, briefly but repeatedly, during the night. The person may nod off during the day for lack of rest, having missed out on sleep cycles that are important for the body and mind.
Aside from golf, doctors know that treating sleep apnea can also lower blood pressure and reduce the risk of heart disease, as well as help thinking.
"More so than many sports, golf has a strong intellectual component, with on-course strategizing, focus and endurance being integral components to achieving good play," a co-author of the study, Dr. Marc Benton of Atlantic Sleep and Pulmonary Associates in Madison, N.J., in a press release. "Obstructive sleep apnea can lead to daytime sleepiness, fatigue and cognitive impairment, all side effects which can negatively impact a person's ability to golf to the best of one's ability."
Golf hasn't been the first carrot given to sleep apnea patients. Promising a boost on a favorite hobby -- whether it be golf, crosswords or bowling -- could be a quick way to get a patient to agree to put up with a CPAP.
But Dr. Mark Dyken of the University of Iowa said those little nudges could backfire. Dyken remembered a particularly angry patient who was referred to him for a second opinion after trying the CPAP treatment.
Dyken said although the woman felt better during the day, she didn't want to continue treatment until she got better at math. Unfortunately, he said, she might not have been very good at math to begin with.
"She said to me, 'I work at a bank and he [the doctor] told me I would be doing the calculations better during the day, and I'm not,'" said Dyken, a director of the university's Sleep Disorders Center.
Helping Sleep Apnea Can't Fix Everything
Dr. Won Y. Lee, the medical director of the Sleep and Breathing Disorders Center at the University of Texas Southwestern Medical Center, said compliance rates for CPAP may range between 40 percent to 80 percent for various reasons, but the biggest complaint is how the mask feels on the face.
"For some patients, it can be claustrophobic," said Lee. "It can be uncomfortable and cause more sleep problems."
But, Lee said, whether someone continues treatment or not can depend on whether they notice any behavioral effects shortly after they start treatment.
"It depends -- some patients feel an immediate improvement in neurocognitive function, and improvements of sleep quality on the first night of CPAP treatment," said Lee. "Some patients may experience dreams for the first time in years because they never entered into the appropriate stages of sleep, the REM cycle."
But others don't notice a difference the next day, and Lee said doctors have only a limited set of alternatives for people who can't tolerate the CPAP.
If all attempts at fitting a person with a CPAP or training them in how to use the device fail, Lee said doctors may try surgery. But that's drastic, and the success rate for surgery is 40 percent to 50 percent.
Some patients with mild sleep apnea might try an oral appliance, but Lee said these may lead to headaches or bite problems -- all the more reason doctors push for people to try the CPAP device.
Forget Golf. What About Driving?
If dreams, golf or clear thinking aren't going to motivate you, doctors said perhaps other health benefits will.
"Golf scores are nice; it's entertainment, it's important," said Dyken. "It's more pleasant to read than death on the highway."
Dyken said he thinks highway deaths are an important reason to treat sleep apnea. Truckers who fall asleep at the wheel and cause accidents, he said, will take an average of 4.2 people to the grave with them. Dyken said treating key professionals -- pilots, truckers, or even doctors -- for sleep apnea may save the country money and lives.