Aaron Figgins thought he was a good sleeper. This hard-working farmer from Mt. Crawford seldom, if ever, awoke in the middle of the night and usually got seven or eight hours of sleep per night—essential for a man engaged in hard physical labor. So if he was sleeping soundly, why was he unbearably tired throughout the day?
Figgins, 32, first suspected that he wasn’t, in fact, such a good sleeper when his wife began waking him up in the middle of the night.
“She could tell that I wasn’t breathing,” he says. “I’d just stop breathing altogether, and she would have to wake me up to get me going again.”
But the days were the worst. Figgins was perfectly exhausted all day long.
“I would get up in the morning after having slept for eight hours, and it felt as if I hadn’t slept a bit,” he recalls. “It was as if I hadn’t gone to bed at all. I would drag all day long. In the afternoons, when I had to drive between farms, it was almost impossible to stay awake. In fact, I know I fell asleep at the wheel several times. That worried me—plus the fact that I operated tractors and heavy equipment all day. I could easily have had a fatal accident.”
“My livelihood depends on my driving,” he continues. “If I can’t stay awake and drive, I can’t work. I had to figure it out.”
Figgins’ doctor referred him to the Sleep Center at Sentara RMH Medical Center—a state-of-the-art facility accredited by the American Academy of Sleep Medicine that provides evaluation, diagnosis and treatment of disorders that occur during sleep, as well as disorders that affect alertness. In late May 2020, Figgins checked into the center for his overnight sleep evaluation by a team of board-certified sleep medicine physicians and technologists.
“They hooked me up to a series of monitors, and I went to sleep,” Figgins says. “The problem revealed itself very quickly. The monitors showed I stopped breathing 31 times an hour, and the diagnosis was severe obstructive sleep apnea.”
According to the Mayo Clinic, obstructive sleep apnea (OSA) occurs when the muscles of the throat intermittently relax and block the airway during sleep. One of the noticeable warning signs of OSA is snoring; another is not breathing normally during sleep.
Fouzia Siddiqui, MD, FAAN, medical director of the Sleep Center, says there are several causes of OSA, including a person’s anatomical features, the positioning of the person’s neck, the size of the tonsils and size of the tongue.
“Some of these factors are genetically determined,” notes Dr. Siddiqui. “The next most common cause of OSA is being overweight and obesity. Obesity can lead to a narrowing of the upper airway and subsequently contribute to OSA. Alcohol and sedatives also can cause the upper airway to relax and collapse, causing apneas.”
Dr. Siddiqui also cites cigarette smoking, nasal congestion and certain medical problems like hypothyroidism and acromegaly as additional causes of OSA.
“Some families are predisposed to obstructive sleep apnea just due to their facial structures,” she says. “Patients who have recently had strokes also have a higher chance of developing OSA.”
Figgins’ decision to seek medical attention was definitely the right thing to do, she says. Ignoring sleep apnea can have severe—even fatal—consequences.
“Sleep apnea is an independent risk factor for stroke,” she adds. “Other cardiovascular conditions associated with OSA include coronary artery disease, congestive heart failure, atrial fibrillation and hypertension. OSA also can contribute to metabolic syndrome and can worsen diabetes.”
But that’s not all. Dr. Siddiqui says multiple disruptions of sleep at night and poor quality of sleep can cause problems with short-term memory and lack of attention and focus during the daytime. The feeling of exhaustion and excessive tiredness during the day can lead to inactivity, which contributes to obesity and weight gain.
A Breath of Fresh Air
With 31 instances of sleep disruption per hour at night, Figgins’ case was severe enough that no other option than the “gold standard”—the continuous positive airway pressure (CPAP) machine—was considered as a treatment. The CPAP produces a continuous, pressure-controlled flow of air that travels through a hose and into a mask worn by the sleeper. The air keeps the sleeper’s airway open throughout the night, thereby eliminating snoring and instances of breathing cessation.
Figgins bought his CPAP locally and began using it in early June, with instructions to use it at least four hours per night. He says sleeping with the CPAP took some getting used to, but eventually he was using it throughout the night and getting as many as seven hours of good sleep.
“I have noticed a huge difference,” he says. “I used to wake up in the morning with a headache. My headaches have just about disappeared. I can now work throughout the day, all day long, and I don’t get tired. Best of all, I’m no longer sleepy on the road.”
Figgins’ wife is also happy with his improved situation. “She can now get some sleep and not have to worry about me,” he says.
The Dark Side of Sleep
Tracy Kimble lifted his head from his school desk and shook off the effects of a deep sleep. The classroom was empty. He looked at the clock on the wall—many hours had passed. Kimble panicked at first, but he quickly discovered that he had been “pranked” by his fellow high school senior classmates. They had set the clock forward and then sneaked out of the classroom, leaving Kimble alone and asleep at his desk.
It was meant to be a good-natured joke, since Kimble was famous for taking naps at his desk and other places throughout the day. But it wasn’t really funny. Rather than simply catching a few winks throughout the day, he was suffering from a chronic, severe, incurable sleep disorder known as narcolepsy.
Narcolepsy is characterized by overwhelming daytime drowsiness and sudden attacks of sleep, explains Dr. Siddiqui. People with narcolepsy often find it difficult, if not impossible, to stay awake for long periods, regardless of the circumstances. Worse yet, sufferers can experience a sudden loss of muscle tone (cataplexy), sleep paralysis (the inability to move or speak when falling asleep or waking up), and hallucinations.
“I don’t know how long I’ve had it,” says Kimble, a West Virginia native who moved to Harrisonburg at the age of 18 to work at Sentara RMH. “I’m guessing I’ve had it my whole life, since there are so many pictures of me growing up in which I’m asleep.”
Kimble says he thought his bouts with drowsiness as an adult were the result of “burning the candle at both ends”—that is, going to school while holding down a job. So when he got kicked out of some college classes for sleeping, and was unable to hear his alarm going off in the morning, he chalked it up to an overly busy lifestyle.
But in 2010, at age 23, Kimble went to his primary care physician for a different problem. When the doctor entered the examination room, Kimble was half asleep. The doctor started probing and asking questions, which ultimately led to a sleep study at the Sentara Sleep Center.
“The study was easy to do at night,” says Kimble. “You just go to sleep and they monitor you all night long. But they also did a different type of sleep test the following day. They’d make me stay awake for two hours, then hook me up to the monitors and let me take a 20-minute nap. They’d keep me awake for two more hours, then let me take another nap. And so on. I took five naps in all, and each time I fell asleep within five minutes, and went into REM (rapid eye movement) sleep three times.”
Kimble was quickly diagnosed with narcolepsy. While there is no known cure, there are treatments—and Kimble was eager to find the one that was right for him. As a cardiac interventional technologist at Sentara RMH, his duties keep him busy assisting physicians and operating equipment during many different procedures, so being sharp and alert is essential.
“So is getting to work on time,” he says with a laugh.
At first, he was prescribed amphetamines to keep him awake during the day. That worked for a while but became less effective over time. Now he takes a medication at night that puts him into a deep sleep for several hours. He sets an alarm to get up at 2 a.m. to take a second dose that helps him stay asleep for the rest of the night. He takes yet another medication to help him stay awake during the day.
“My life is absolutely better than it was,” says Kimble, who is married and has one child and another on the way. “I don’t know what I would have done or where I would have been without the sleep test and the medications. I didn’t know how bad I felt until I found out what was wrong and got treatment for it.”
A Better Night’s Sleep
Other common sleep disorders include insomnia, restless leg syndrome, periodic limb movement disorder, REM sleep behavior disorder, advanced sleep phase syndrome and delayed sleep phase syndrome. It is estimated that one in three Americans suffers from some form of sleep disorder or lack of sufficient sleep.
The Sentara Sleep Center provides evaluation, diagnosis and treatment of these and other disorders that occur during sleep, as well as those that affect alertness. Sleep studies are conducted in a comfortable, state-of-the-art facility centrally located in Harrisonburg. For more information, visit Sentara.com or contact the Sentara Sleep Center at 540-564-5500.