The consequences of ignoring the condition can be severe, but the health system puts up barriers to treatment.

The CPAP mask is awkward, but it’s not as intrusive as you might think.
The CPAP mask is awkward, but it’s not as intrusive as you might think.Credit…Reed Saxon/Associated Press

Both of us have sleep apnea, and both of us receive treatment that makes a world of difference.

It could make a big difference in your life, too. Sleep apnea is quite common, with estimates that it affects up to 17 percent of men and 9 percent of women ages 50 to 70, and 10 percent of men and 3 percent of women 30 to 49.

But there’s a problem. In the American health system, we often make it hard for people to get care, and the same is true here.

Obstructive sleep apnea is when the upper airway collapses during sleep, leading to periods of, well, not breathing. About 24 million Americans have sleep apnea and don’t know it, research suggests, and many who do know don’t get treatment.

The consequences can be severe. It’s a leading cause of vehicle accidents, as apnea-afflicted drivers fall asleep behind the wheel. Snoring and sleep apnea are on the same spectrum and are associated with Type 2 diabetes in adults. Treatment is associated with improvements in insulin resistance. Having sleep apnea, and not treating it, increases the risk of postoperative cardiovascular surgery complications.

Treating sleep apnea improves sleep duration and quality. People who sleep better are much happier and healthier in general. Reducing snoring also helps partners sleep better.

We were treated with continuous positive airway pressure (CPAP).

It’s intrusive, though not nearly as much as we had feared. Each night we strap on masks connected to CPAP machines. The modern machines are silent. And we both use masks that cover only our nostrils, though others need full face masks. The air that the machines push through the masks keeps our airways open. It takes some getting used to, but we adapted within a week. This isn’t to say that it’s not a big deal for many people — it can be. But it’s not as scary as many fear.

The difference in sleep is well worth the effort of adjustment. It’s easier both to fall and stay asleep. We feel more refreshed and less tired all day. The machines these days come with apps that track and grade your use of them, and both of us (being the obsessives we are) manage to squeak out a nearly perfect score nightly. Since being prescribed the therapy, we have used it pretty much every single night, and even bought smaller machines for travel.

But many people avoid diagnosis or, once diagnosed, don’t follow through with therapy. Others find therapy harder than we did and give up. We can sympathize. Though we adapted to our machines relatively easily, we had considerable trouble getting them in the first place. Giving up would have been the easy, short-term thing to do.

There are some alternatives to CPAP with evidence of effectiveness. Some people sleep better with oral appliances or nasal patches. Some are treated with surgery, but that’s usually reserved for the worst cases.

A diagnosis of obstructive sleep apnea requires an overnight sleep study. Until recently, this meant sleeping in a lab, attached to measuring machines all night long. It was expensive, hard to schedule, and usually left you tired the next day. Austin did this, and it was one of the worst nights of sleep in his life. Still, he considers it worth it because it confirmed the diagnosis and made the need for treatment clear.

These days, sleep studies can be done at home with machines lent to you. Aaron was diagnosed at home, though it still required an appointment to explain how to use the testing machines. It cost a fair amount, and he had to return the machines the next day. All of this took time. Austin might have been diagnosed at home, but the machines he was given for home testing failed, another source of frustration and wasted time.

After the results came back confirming sleep apnea, we both had to have another appointment with a sleep specialist. That took more time and another co-payment, though its only purpose seemed to be to get a prescription for therapy. After that, we had to deal with a sleep center or respiratory device supplier for another appointment for equipment training and distribution.

All of this wasn’t cheap, neither for equipment nor for the time missed from work for the appointments. We’re lucky that we could do all this, but for many it is a barrier to care.

Insurance companies don’t make things easy, either. Each device can easily run $1,000; insurers don’t want to pay for equipment that isn’t used. To justify the expense, insurance companies usually monitor the machines’ use to make sure they’re being employed. While we enjoyed the app that told us how compliant we were being, others have found themselves being refused coverage by their insurance because the app reported they failed to use the machine enough.

All of these issues make obstructive sleep apnea a condition that is hard to get a handle on. There’s failure on both ends. Many people who receive the diagnosis don’t make use of a therapy that might improve their lives. But even more go undiagnosed. This is not uncommon in the health system: Americans complain that many conditions, like attention deficit hyperactivity disorder and even breast cancer, are both under- and over-diagnosed at the same time.

Still, because of the number of cases of sleep apnea going untreated, some have proposed universal screening.Officials at the U.S. Preventive Services Task Force weighed in two years ago. They noted that the benefits of screening would include earlier diagnosis, leading to better sleep and quality of life. The harms include treatment side effects like discomfort in the nose or mouth area from using a mask.

Given such a trade-off, it seems like screening would be a good idea. But there was too little evidence to recommend looking for it in people who have no symptoms. The task force issued an “I,” which calls for more research.

Another thought: that we not even bother with the sleep studies. The CPAP machines are now so sophisticated that they can record sleep apnea episodes and fix them. Doctors could just give the machines out — instead of ordering home sleep studies — and use them to determine if patients (1) need the devices and (2) would actually use them. Given how expensive sleep studies are, this might even save money. For now, though, this is just an idea, not anything anyone has put into practice.


Many Americans complain about their sleep. They turn to medications, like Ambien. They turn to supplements, like melatonin. They turn to devices and software. These days, they even seem to turn to unproven solutions like CBD oil. Many, however, probably suffer from sleep apnea. What they need are open airways while they sleep, and a health care system that makes it easier for them to get them.


Why does my teenager want to fight with me?

Imagini pentru Teens and Parents in Conflict

“There’s no point in talking to you: You don’t understand me. You don’t even know me.”

A teen spits these words at a parent, who is hurt and outraged. How can her own child say these things? She’s worked hard to know her child, learning to read his feelings from voice and gesture, learning to place his words in the context of his day-to-day life. How can he now say to her, “You don’t know who I really am.”

Nothing shakes a parent’s confidence as much as the onset of a son’s or daughter’s adolescence. The communication that flowed easily, with words, glances and touch, becomes a minefield. Judith says that her once affectionate daughter is now, at 14, surly and guarded, with “porcupine-like spines that bristle whenever I get near her.” Pat says that his 15-year-old son, Greg, “gives off hate rays the minute I step into the room. His response to everything I say is a groan. Sometimes I get furious, but mostly he manages to make me as unhappy as he seems to be.”

Recent discoveries that the human brain undergoes specific and dramatic development during adolescence (with the frontal lobes, which allow us to organize sequences of actions, think ahead and control impulses, bulking up in early adolescence before gradually shrinking back) offer new physiological “explanations” of teen behavior, particularly their impulsiveness. At the bulking stage, there may be too many synapses for the brain to work efficiently; the mental capacity for decision-making, judgment, and control is not mature until age 24. But no underlying physiology explains the teens’ experience of parents.

Nor do raging hormones — an older style “explanation” — account for the apparently irrational moodiness of teens. Though hormones play a role in human feelings, the real task of adolescence, and the real cause of turbulence, is the teen’s own uncertainty about who he is, alongside his eager need to establish a sense of identity.

This involves self-questioning, self-discovery, and self-development across a range of issues, including gender, faith, intellect, and relationship. A sense of who we are is no mere luxury; we need it to feel alive. Without it, we feel worthless. A teen often looks upon peers as models: “I don’t know who I am, but I know who he is, so I’ll be like him” is the underlying thought. Parents become mirrors: Teens want that mirror to reflect back to them the vividness and clarity they themselves do not feel.

Arguments with parents can often be understood in this context. While those common teenager/parent quarrels, which explode every few days, are, at a superficial level, about curfews, homework, housework, and respect, a teenager’s real focus is on a parent’s acknowledgement of his maturity, capability, and human value. “No, you can’t go out tonight” causes more than a glitch in a teen’s social diary; it implies that a parent doesn’t trust him to make his own decisions. And in a teen’s eyes, that’s not only unfair; it’s humiliating. Even apparently minor exchanges can trigger major reactions, making a parent feel, “Everything I say is wrong!” A parent asks a checking-up question, and the teen feels like a little child again. “Have you got your keys?” and, “Do you have enough money for the bus?” are loaded with the implication, “You’re not able to look after yourself.” These questions would be easily tolerated if uttered by a concerned friend, but from a parent they pinch on a teen’s own doubts. Feeling threatened by the kid who can’t remember to take his lunch, his keys, or his money, he blames the parent for reminding him of the child-self still residing within him.article continues after advertisement

It is no wonder, then, that teens can be quick to reject the embraces and endearments that were once daily currency in his life with a parent. “Oh, come on,” a teen protests as a parent gives him a good-morning hug: A parent may interpret this as a stinging rejection of their entire relationship, but the teen is simply acting out his ambivalence. He feels trapped both by the comfort he is inclined to experience from a parent’s hug and by his wish to expel the previous child-self who welcomes that comfort.

Teens get so heated in arguments with parents because so much is at stake: They are fighting to change their relationship with the parent, to make the parent see that they are not the child the parent thinks she knows. They want to shake the parent into an awareness of the new and exciting person they hope to become. Quiet conversations, as opposed to quarrels, do not do justice to the drama of the teens’ feelings. In argument, you push yourself and the person you are arguing with into what Annie Rogers calls “a rawness of feeling, where you say more than you otherwise would.”

Perversely, teens expect the parent to appreciate who they have become, even before they themselves know. Therefore, in the emotional exposure of quarrels with parents, teens clarify and demand recognition for the new person they see themselves to be — or on the way to being. The arguments can put the entire family into a spin as each parent has a different interpretation of “the problem,” and siblings complain that their parents are “dense” for failing to understand the teen’s outbursts.

What my research reassuringly shows is that quarreling with your teen doesn’t necessarily mean you have a bad relationship. The quality of a parent/teen bond has several measures: There is the comfort of simply being together and the willingness to share a range of daily experiences and to express a range of feelings — happiness as well as unhappiness. Some parents and teens who engage in frequent arguments have, by these measures, a good relationship: What matters is that a quarrel doesn’t end with two people simply brooding over their own anger. What a teen is aiming for, after all, is to gain recognition and new respect for the parents he still loves.


Your guide to gaining emotional freedom.

Peter Atkins/Dollarphotoclub

One of the many wonders of your brain is how masterfully it rationalizes your behavior.

Something occurs, you react, and then your brain instantly concocts a reason for your reaction that seems to justify your behavior even if the reason makes no sense. For example, you get very angry because you can’t find a report you were working on. You blame the company for giving you insufficient space, the cleaners for moving things around on your desk, or your boss for giving you a stupid task or deadline. You ignore the reasons you are tired and your patience is thin. You suppress your unhappiness with your boss or your life.

“The ingenuity of self-deception is inexhaustible,” wrote essayist Hannah Moore in 1881. The act of rationalizing is so quick, the best you can do is to recognize when it occurs and choose to consider what else could be causing your reaction.

The first step is to accept responsibility for your reactions.

Accept yourself as powerful instead of as victim to remove the veil of self-deception. When you seek to identify what is triggering how you feel in the moment, you give yourself the chance to feel differently if you want to. You will also have more clarity on what you need to do or what you need to ask for to change your circumstances.

What would your life look like if you were in control of your reactions? How free would you feel if you lived your life by choice? If these questions inspire you to diligently practice the steps for emotional freedom, read on.

The second step is to recognize that you are having an emotional reaction as soon as it begins to appear in your body.

According to neuroscientist Antonio Damasio, author of Looking for Spinoza: Joy, Sorrow and the Feeling Brain, at any moment, your rate of breathing, blood flow, tension in your muscles and constriction in your gut represents a pattern you can identify as a feeling. The sooner you recognize that you are breathing quickly or not at all, that certain muscles in your body tightened, or that you feel pressure in your gut or heart, stop and ask yourself what you are feeling and why. You can download a list of emotional states and an exercise to increase your awareness of emotions on this page.

Don’t judge or fear your emotions. No matter what you learned about the evils of emotions, if you don’t recognize your feelings, you can’t change them, negatively impacting your relationships, job performance, and overall happiness.

If the emotion is related to fear, anger, or sadness, the third step is to determine what triggered the emotion.

What do you think you lost or what did you not get that you expected or desired to have?

The strengths that have helped in life are also your greatest emotional triggers when you feel someone is not honoring one of them. When your brain perceives that someone has taken or plans to take one of these important things away from you, your emotions are triggered.article continues after advertisement

The quicker you notice an emotion is triggered, the sooner you can discover if the threat is real or not.

The following list includes some of the most common emotional triggers, meaning you react when you feel as though you aren’t getting or will not get one of these needs met.

acceptance                   respect                      be liked

be understood              be needed                 be valued

be in control                 be right                      be treated fairly

attention                       comfort                      freedom

peacefulness               balance                      consistency

order                            predictability              love

safety                           feel included              autonomy

fun                               new challenges          independence 

Choose three items from the list that most often set off your emotions when you don’t get these needs met. Be honest with yourself. Which three needs, when not met, will likely trigger a reaction in you? Identify the needs that you hold most dear.

Some of these needs will be important to you. Others will hold no emotional charge for you. Some seem to overlap; choose the words you feel strongly about and begin to notice when your reactions are tied to unmet needs.

Needs are not bad. You have these needs because at some point in your life, the need served you. For example, your experiences may have taught you that success in life depends on maintaining control, establishing a safe environment, and having people around you who appreciate your intelligence. However, the more you are attached to having control, safety and being seen as smart, the more your brain will be on the lookout for circumstances that deny you your needs. The unmet need or threat becomes an emotional trigger.article continues after advertisement

The fourth step is to choose what you want to feel and what you want to do.

With practice, the reaction to your emotional triggers could subside, but they may never go away. The best you can do is to quickly identify when an emotion is triggered and then choose what to say or do next.

Ask yourself: Are you really losing this need or not? Is the person actively denying your need or are you taking the situation too personally? If it’s true that someone is ignoring your need or blocking you from achieving it, can you either ask for what you need or, if it doesn’t really matter, can you let the need go for now?

Choose to ask for what you need, let it go if you honestly feel that asking for what you need will have no value, or do something else to get your need met.

The fifth step is to actively shift your emotional state.

You can practice this step at any time, even when you first notice a reaction to help you think through your triggers and responses. When you determine what you want to do next, shift into the emotion that will help you get the best results.

Relax – breathe and release the tension in your body.

Detach – clear your mind of all thoughts.

Center – drop your awareness to the center of your body just below your navel.

Focus – choose one keyword that represents how you want to feel in this moment. Breathe in the word and allow yourself to feel the shift.article continues after advertisement

Stop trying to managing your emotions. Instead, choose to feel something different when an emotion arises. This is how you gain emotional freedom.


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