Sleep apnea robs sufferers of vigor, threatens health A WAKE-UP CALL

October 18, 1994|By Jonathan Bor | Jonathan Bor,Sun Staff Writer

At first, he excused his fatigue as a symptom of advancing age, expanding girth or the rigors of his grinding schedule.

There were nights when Del. Howard "Pete" Rawlings struggled to stay awake during the tedious drive home from Annapolis. Or the time the Baltimore Democrat drifted off while dining with friends at an elegant restaurant in Manhattan.

"He just nodded off," said his wife, Dr. Nina Rawlings, a pediatrician who implored him without success to see a doctor. "I was just glad I was sitting next to him. I kept bumping his knee."

But when Mr. Rawlings fell asleep in his chair during a crucial meeting last fall of the Governor's Commission on School Funding, he began to suspect a deeper problem. A colleague who witnessed his public doze begged him to get help. Mr. Rawlings relented.

With that, he was on his way toward a diagnosis of obstructive sleep apnea, a nighttime breathing disorder that afflicts millions of Americans, including many who have no idea why they drag through the day regardless of how long they sleep at night.

Those afflicted frequently stop breathing for 10, 15 and sometimes 20 seconds at a time, each time snapping out of it with a gasping reflex that disrupts their natural sleep cycles. Usually, the gasp doesn't wake them up -- but their rocky sleep deprives them of the rest they need.

In the year since his diagnosis, Mr. Rawlings has been rejuvenated.

His treatment, a mask called a CPAP that forces oxygen into his airway during sleep, has expanded his lung capacity, raised his blood-oxygen levels and stoked him with more energy than he has enjoyed in years.

He also has shed more than 50 pounds with a low-calorie diet, reducing not only his waistline but excess tissues in his throat that may have contributed to his apnea.

News of his transformation so impressed officials at the Liberty Medical Center, a hospital in his district, that last month they dedicated their new sleep disorders unit to him despite the fact he was treated elsewhere.

A brass plaque bearing his likeness will soon be placed on the wall of the fourth-floor unit.

Mr. Rawlings, 57, was honored because he is a sleep-science success story who is well-known to the community, said hospital president Everard O. Rutledge. And he's been a good friend to Liberty Medical Center, helping it obtain a $2 million appropriation for its Urban Medical Institute, a program of

preventive medicine and primary care aimed at its largely African-American constituency. Mr. Rutledge said the sleep center fits squarely into Liberty's emphasis on treating the basic problems that can hinder a person's ability to function.

"We were filling what we believed was a void," Mr. Rutledge said. "People are saying, 'Why am I constantly tired, listless? Why am I having fits of depression?'"

Obstructive apnea is the most common problem treated at sleep centers such as Liberty's, but they diagnose other afflictions as well. These include restless leg syndrome, a condition in which people are kept awake by involuntary and sometimes painful leg spasms. Another condition is central apnea, on-and-off-again breathing that has a neurological rather than a respiratory cause.

Mr. Rawlings didn't expect any drama when he showed up at his doctor's office, the day after he decided to explore the reasons for his fatigue. Two routine tests, however, showed that oxygen levels in his blood were alarmingly low, and that raised fears of a dangerous heart condition.

Quickly, his doctor called an ambulance to deliver him to the emergency room at the University of Maryland Medical Center -- just a block away. In a calmer moment, he could have walked the distance in less than five minutes.

"Here, I'm a politician, and I think I'm healthy except for being tired, and I'm concerned about my public image, and here they strap me down and send one of those life-support ambulances," he said. "They're pushing me out of the building onto Paca Street, and I'm thinking: 'I just know somebody's going to recognize me.' "

Somebody did, of course, and called his wife.

Happily, specialists determined that he did not have an underlying heart or lung ailment, even though his lungs weren't inflating as far as they should. "They believed it was correctable once they found the problem," he said.

Doctors said it was worth exploring the possibility that a sleep disorder was preventing him from drawing enough air at night. They referred him to the sleep center at the Johns Hopkins Bayview Medical Center for evaluation.

He soon found himself lying in a quiet room, electrodes and motion detectors attached to various points on his head and chest. In another room, technicians tracked his breathing and sleep patterns, heart rate, eye movements and chest expansions on a bank of computer monitors.

Conclusive proof

The usual routine is to sleep through the night, and to receive an analysis the next day.

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