I think it was in my first practice, straight out of residency, that I learned about sleep apnea.  He was a private patient, a man about 40, who had his sleep apnea treated when some enterprising ENT (Ear, Nose and Throat doctor) fried his too-large tonsils.

Within the day or two it took the surgery to heal, he came to the office to tell me that his symptoms of anxiety and depression were totally gone. Well, if I had trouble breathing, I would be anxious and depressed too.  You want to get that oxygen, continuously.

Even if the tests , which technology has simplified over the years, show that you’ve got plenty enough oxygen in your blood, the fear of losing oxygen has got to be significant.  I remember, even as a little kid, with hay fever attacks, what it felt like to gasp for air. I can only start to imagine what it is like for those who gasp for air in the middle of the night.

So at a later time, a different patient shows up, a 53 year old man, and he tells me he wants some Xanax or at least some Ativan.  I have someone count his respirations — 14 in a minute, not too bad. He is using the muscles in his neck to hike up his chest to breathe. He has recently stopped smoking, much to his credit, but still has a solid diagnosis of COPD, (chronic obstructive lung disease) and this guy got it in spades, but the question remains does he have sleep apnea?

We are lucky.  His diagnosis was confirmed by a sleep study.  This means someone had to watch and measure him all night. He is still shocked that I made the diagnosis just by asking questions.  Not that it is hard to tell what is going on.  I heard a little bit of wheezing without a stethoscope.

First things first — I was not going to prescribe anything that could depress his heart or breathing.  That meant no Xanax.  To say that he was not happy with me was — at best — a gross understatement.

Then I got up the guts to tell him the truth. “Until we treat your sleep apnea, your anxiety and depression are NOT going to get better.”

Now when I first started telling this to people, the relationship between depression and anxiety and sleep disorders may have been something someone could debate.  Not now.
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