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 can be a life saver

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.

Black people are the group most threatened by sleep apnea

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.

African Americans face a higher risk for sleep apnea than any other ethnic group in the United States.

— Penn State Hershey Medical Center report

The death of football star Reggie White

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].

The warning signs of 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.

Do you ever have problems with snoring at night and feeling tired during the day?

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My experience with sleep apnea

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.

Source

CPAP is the best known treatment for sleep apnea

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.

African Americans are the least likely to use a CPAP machine

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.

The strongest predictor that a sleep apnea patient will not continue to use a CPAP machine is simply that the patient is black.

Why people don't use their CPAP

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?

A CPAP mask
A CPAP mask | Source

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.

Is using a CPAP machine worth the trouble?

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."

More and more African Americans are discovering the health and lifestyle benefits of CPAP therapy. Former basketball star Shaquille O'Neal is one of them. He has partnered with Harvard's Sleep and Health Education Program to help spread the word through the following video.

Shaq Attacks Sleep Apnea

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

© 2016 Ronald E. Franklin

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Comments 22 comments

Ericdierker profile image

Ericdierker 10 months ago from Spring Valley, CA. U.S.A.

Very interesting. It sure looks uncomfortable, but I suppose if I needed I would get used to it.


janshares profile image

janshares 10 months ago from Washington, DC

Fascinating and informative article, Ronald. I had no idea how this disorder affects our community and the resistance to treatment. Thanks for this thorough explanation of African Americans and sleep apnea and the CPAP machine. Always a pleasure to read your work.


Digital MD profile image

Digital MD 10 months ago

Very informative hub! Sleeping with a mask on has been one great barrier for patients with sleep apnea. Some patients though have times that can intermittently use the mask at some nights, with little to no adverse effects.


RonElFran profile image

RonElFran 10 months ago from Mechanicsburg, PA Author

Thanks, Eric. The fact that most people can get used to it if they stick with it through the initial discomfort is really the message I wanted to convey.


RonElFran profile image

RonElFran 10 months ago from Mechanicsburg, PA Author

Thanks so much, Janis. In my experience most African Americans are totally unaware of the dangers of sleep apnea, and many who suffer from it don't realize what the problem is. That needs to change!


RonElFran profile image

RonElFran 10 months ago from Mechanicsburg, PA Author

Many thanks, Digital MD. There are some people who just can't seem to ever get comfortable with the mask - Reggie White was one of them. But there are other therapies. The big issue is getting people aware of the problem and then determined to find a solution that works for them.


Duane Townsend profile image

Duane Townsend 10 months ago from Detroit

An incredibly informative Hub that hits home for me.

I've experienced the classic symptoms of sleep apnea....especially the morning headaches, not regularly, but enough for me to have it checked out.

I had retinal laser surgery last summer. The surgeon said the retinal bleed was most likely caused by a small stroke.

Thanks for an illuminating Hub.


RonElFran profile image

RonElFran 10 months ago from Mechanicsburg, PA Author

Hi, Duane. If you haven't already, I hope you will get checked out for sleep apnea as soon as you can. Maybe your retinal issue was a wake up call. Thanks for sharing.


MsDora profile image

MsDora 10 months ago from The Caribbean

Thanks for the information and explanations on this device. You made me aware how serious Sleep Apnea is. Surely, this makes us understand if we did not before.


RonElFran profile image

RonElFran 10 months ago from Mechanicsburg, PA Author

Thanks, MsDora. I'm hoping to encourage some people who otherwise wouldn't to get checked for OSA, and give CPAP a chance if that's what they need.


DWDavisRSL profile image

DWDavisRSL 10 months ago from Eastern NC

As a fellow OSA sufferer who has been using a CPAP for 16 years I can tell you that it made and continues to make a huge difference in my life. Thank you for this excellent and informative Hub on the subject. I will be sharing this on FB, Twitter, and G+.


Jennifer Mugrage profile image

Jennifer Mugrage 10 months ago from Columbus, Ohio

Thanks for this personal testimony - and the video. My brother-in-law has a story very similar to yours. He has been using the CPAP machine for years and is much more alert during the day. (I don't know how long it took him to get used to it.) He can take it on the road - to hotels, family events, etc., and it seems to work just fine.

He initially did not realize that he had sleep apnea because there were other health conditions and stresses in his life to which he attributed his being tired all the time.


RonElFran profile image

RonElFran 10 months ago from Mechanicsburg, PA Author

Thanks so much, DWDavisRSL. And thanks for helping get the word out. Far too many people have the symptoms but remain clueless about the cause and treatment.


RonElFran profile image

RonElFran 10 months ago from Mechanicsburg, PA Author

Hi, Jennifer. Like your brother-in-law I take my CPAP along when I travel. The few times I didn't, thinking it too much trouble, I regretted it. Thanks for sharing.


Edward J. Palumbo profile image

Edward J. Palumbo 10 months ago from Tualatin, OR

I'm 69 years old, have been using a CPAP machine for several years and, admittedly, it has its inconveniences. It works best in the supine position, flat on my back, but often leaks if I attempt to change position and sleep on my left or right side. If my facial expression changes or my jaw opens, some masks leak. If I fall asleep promptly, I will often sleep through the night but if I awaken, for any reason, I often find it difficult to fall back to sleep. My original CPAP machine was replaced in time by a more modern and noticeably quieter machine, so the technology is improving. I use more than one model of CPAP mask because there are times that the pressure points of a mask become uncomfortable, and moving to a different mask may be a temporary relief. The CPAP machine may be inconvenient, but the health benefits in using it consistently (e.g., lower blood pressure, better quality or sleep, more alert and productive during the waking hours, etc.) override those inconveniences. If you are new to CPAP use, be patient with it, Position yourself as comfortably as possible before you initiate your sleep cycle. Yes, there are nights when you simply can't be comfortable, won't be able to sleep with it. If you must, take a "break" but return to it the following night.


RonElFran profile image

RonElFran 10 months ago from Mechanicsburg, PA Author

Hi, Edward. I'm glad the CPAP is working for you. As you say, it can still be a nuisance sometimes, but in the end, it's worth it. That's a good point about swapping out masks when they aren't working as well for you. I recently got a new mask but didn't immediately use it because I thought my current one was ok. But when I finally started using the new one, which was of the same type as the old one, the improvement was very noticeable. All in all, CPAP is far from perfect, but it's well worth the time and effort required to adjust to it. Thanks for sharing your experience.


paperfacets profile image

paperfacets 10 months ago from La Verne, CA

I absolutely do not like using the mask and headgear at night. I do it anyway, because my blood pressure stabilized to 120-130 after I used it every night for three months. I snored and was losing 30% of the oxygen I needed for a stress free sleep. It manifested itself in blood pressure.


RonElFran profile image

RonElFran 10 months ago from Mechanicsburg, PA Author

paperfacets, that's a great point about blood pressure. And you're certainly right that no one enjoys wearing that mask! But having the self discipline to "do it anyway" makes all the difference. Thanks for sharing.


ladyguitarpicker profile image

ladyguitarpicker 10 months ago from 3460NW 50 St Bell, Fl32619

Ron, I agree with you the CPAP machine gives a better quality of sleep. I hate my machine and often find the mask on the floor in the morning. It will soon be a year and I am still trying to adjust. It is the same with most of the people I have talked to. Great article, Stella


RonElFran profile image

RonElFran 10 months ago from Mechanicsburg, PA Author

Hello, Stella. I commend you for sticking with the CPAP even though it's been hard to adjust. With the trouble you are having, I'm wondering if the particular model of mask you are using is really the best fit for you. If you haven't done so yet, it might be worth the effort to see if another style of mask might work better for you. Some people, for example, find that nostril plugs are more comfortable for them than an on-the-face mask. I hope you find a solution. Don't give up!


FlourishAnyway profile image

FlourishAnyway 9 months ago from USA

I surely didn't know there were differences in CPAP adoption and compliance across different racial groups. I had a machine for 6 months and didn't exactly hate it, but the masks they fitted me with hurt and caused acne near my nose. I'd take it off some time during the night and find it on the floor in the morning. Tired of looking like Rudolph and not sure that it was helping me, I turned it in. I'm sure glad it's working better for you. I have heard that people either love it or hate it.


RonElFran profile image

RonElFran 9 months ago from Mechanicsburg, PA Author

FlourishAnyway, I'm really sorry CPAP didn't work for you. There is a significant minority of users who simply can't adjust to the mask. However, there are alternatives, such as nose plugs rather than an on-the-face mask. Depends on what pressure you need. Anyway, if you still have the symptoms, I hope you can be fitted with something that you can live with. Thanks for reading and sharing.

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