Most speakers dread the time slot right after lunch, with good reason. The nodding heads and half-mast eyelids are usually blamed on the energy-sapping process of digestion combined with a satisfied state of relaxation. However, published data indicate that 25% of the audience is losing the battle to stay awake for an additional reason; that's the percentage of people who suffer, at some level, from sleep-disordered breathing. They're not just experiencing a post-prandial lull. They are being drawn toward full-blown REM sleep — and have been from the time they got out of bed that morning.
No vending machine energy drink will fix the problem they are living with, and it's a problem that adds up to an estimated $150 billion in lost productivity annually.
In October, 2004, Harvard Business Review published an article entitled "Presenteeism: At Work — But Out of It." Its author Paul Hemp argued that, whereas managers tend to be highly aware of worker absenteeism, they should be more attuned to presenteeism, which finds workers at their posts but prevented by various ailments from performing very well. Hemp wrote about the enervating effects of depression, arthritis, back pain, headaches, heartburn, and more. But what he missed was the real 800-lb gorilla of presenteeism: untreated sleep-disordered breathing.
That omission was understandable almost a decade ago. In the nearly ten years since Hemp wrote his article, we have learned a great deal about the legions of workers whose days begin without a good night's rest, simply because they are unable to breathe normally during sleep due to the spasmodic blockage of their upper airway.
Sleep-disordered breathing includes obstructive sleep apnea (OSA) and central sleep apnea (CSA). OSA occurs when the throat relaxes during sleep and partially or completely blocks the upper airway. OSA sufferers regularly stop breathing for 10 or more seconds, multiple times per night. The oxygen deprivation triggers the brain's wake-up response and there is often a stentorian gasp for air. This can happen hundreds of times a night, though a sufferer usually won't remember waking up. CSA, which is many times less common than sleep-disordered breathing, is caused by a failure of the brain to send signals to the muscles that enable breathing, and similar apneic events occur. CSA is analogous to a sigh.
High Prevalence, Low Treatment Rates
The prevalence of mild to severe sleep-disordered breathing is estimated to be nearly one in four adults and these data are based upon studies from several countries including Canada, Israel, and the U.S. Of those affected by sleep-disordered breathing, fewer than 15 percent have been diagnosed and treated. Left untreated, sleep-disordered breathing sufferers are persistently sleep-deprived and they take that condition with them wherever they go. In their morning commutes, at their desks, in meetings, and getting home again, sleep-disordered breathing sufferers fight the body's irresistible urge to sleep.
The occupational health and safety risks are obvious. Much has been made — and rightfully so — about drowsy truckers and rail operators causing fatalities, but the life-or-death implications extend far beyond these kinds of incidents. And as a public healthcare problem, untreated sleep-disordered breathing is without equal. It has been confirmed as the key driver of hypertension as well as a key participant in heart disease, diabetes, reflux, depression, and more. Given its prevalence, untreated sleep-disordered breathing is driving healthcare costs sky high.
The Good News — Diagnosis and Treatment are Accessible
The most common and effective treatment for sleep-disordered breathing is nasal continuous positive airway pressure (CPAP) therapy, which involves a device that generates a continuous flow of air, and a mask that directs that air flow to the patient's airway through the nares, providing an air splint to maintain healthy breathing.
It used to be that if a person was suspected of having sleep-disordered breathing, they would be directed to a sleep clinic and have to devote a night in a sleep lab for diagnosis and yet another night for calibrating the CPAP device. That is expensive and inefficient. Now patients can conduct a sleep test at home, and be prescribed a therapy that auto-adjusts to their specific breathing patterns and needs. In fact, home sleep testing (HST) coupled with automatic PAP therapy is revolutionizing the sleep-disordered breathing space. HST and APAP are much, much cheaper than attending a sleep clinic and so much more convenient for the patient. And they constitute a solution that is scalable.
When sleep-disordered breathing patients are successfully treated — meaning they adhere to therapy — a ripple effect of positive things happens:
- First, the sleep-disordered breathing patient reaps the benefits of healthy sleep, being alert and more productive during the day. Overall quality of life improves dramatically.
- Second, the progression of any associated co-morbidity, such as hypertension or heart disease, reflux, depression, and so on, are invariably ameliorated and often completely reversed.
- And, finally, the overall cost of healthcare decreases, saving both patient and employer, as well as the healthcare system, money.
Some companies have embraced the ROI of having formal sleep care management programs, which include diagnosis and treatment of sleep-disordered breathing. Those who have not are missing out, not just on reduced healthcare costs, but on the benefit of having workers who are not only present at their posts but doing a job of which they can be proud.