Singing, Snoring, and Sleep Apnea
I’ve been traveling the world since 2019 with “Grace”, the little gray case that holds my CPAP machine, cords, cables, and mask. There is a secret code (a knowing little nod) when I pass other passengers carrying their CPAP cases at the airport. Occasionally, I’ll get some side eye from a passenger who wonders why I’m allowed to carry on a third piece of luggage on board. Flight attendants know that Grace is not luggage. She is a cabin approved medical device. Grace is a life saver.
Disclaimer: This is where I tell you that I am not a doctor or sleep specialist. I’ve included a Mayo Clinic link and some information about sleep apnea at the end of this article.
As a professional singer and voice teacher, I had noticed that my high notes didn’t come as easily, I couldn’t hold notes as long, and I had to breathe more often. I was tired most of the time — singing, teaching, writing, and running a music studio. Who wouldn’t be tired wearing all of those hats? I noticed the brain fog, but blamed it on menopause. What really motivated me to seek medical help, however, was the snoring. I’m talking supersonic, chain saw buzz, very un-ladylike snoring that finally got so bad that my poor sleep deprived husband (who doesn’t snore) had to retreat to the spare bedroom most nights during the work week.
At the end of my annual physical when my primary care nurse practitioner rolled her stool away from the computer and asked, “Anything else?”, I casually mentioned, “Well… uhm…I snore…. really loud.” She rolled back to the computer and started typing. “Hold on”, she said. “This is important. I’m putting in a referral for you to see a sleep specialist as soon as possible.”
She explained that when you have sleep apnea your breathing stops and starts many times throughout the night. Symptoms are loud snoring and waking as you gasp for air, making it impossible to get a restful night’s sleep. Sleep apnea is potentially life threatening because you might stop breathing completely. Many older doctors will tell patients that being overweight causes sleep apnea. “Lose weight and you won’t have sleep apnea.” However, it’s not nearly so simple. My primary care provider had been studying sleep apnea (particular SA in women) and she told me that undiagnosed sleep apnea can actually cause weight gain, along with a host of other medical issues including heart problems, high blood pressure, and atrial fibrillation. When you have sleep apnea you don’t get enough oxygen to your brain so vital functions are affected, especially over time.
A sleep disorder specialist asked me questions about my symptoms and examined my mouth and throat. “Your throat is tiny!” A narrow airway can make you more likely to acquire sleep apnea. Genetics also play a role. I mentioned a family history of sleep apnea — my father and my two younger sisters. “Even the skinny sister!” The doctor reiterated that weight is not always a factor. People of all ages and sizes can have sleep apnea. She suggested that my sleep apnea symptoms may have been delayed until I was nearly 60 due to lifelong singing which strengthens the muscles at the back of the mouth. She cautioned that in severe cases, she has seen tears and fissures in the soft palate (velum) and uvula from aggressive snoring caused by sleep apnea.
According to sleep specialists at NYU Langome Health, “Obstructive sleep apnea is most often caused by a loss of muscle tone in structures in the upper airway. These include the back of the tongue; the soft palate; the uvula; and the tonsils. In most people, these structures are mildly stiff, even during sleep. But in people with obstructive sleep apnea, muscle tone in the upper throat is lost during deep sleep, causing these soft tissues to flop into the airway and obstruct airflow. As a person breathes in and out, the relaxed uvula and soft palate flutter and vibrate, making noise.”
My sleep specialist recommended an overnight sleep study (polysomnogram) to determine the number of times I stopped breathing throughout the night. I arrived at a medical facility and was ushered into a bedroom that looked like a cheap motel room with no-frills furniture and a dollar store nature scene print on the wall. I changed into a nightgown and robe in the bathroom, where there were (presumably) no cameras. A technician applied sleep study “glue” to my head and hair and soon I was covered with electrodes and wires: a belt around my ribs to monitor breathing, electrodes on my head monitoring brain activity, electrodes on my legs monitoring muscle movements, a nasal cannula monitoring air flow, and a bedside microphone recording snoring sounds. “Try to sleep!” Lights were dimmed, but the camera in the corner of the ceiling was a constant reminder that my every motion and sound were being observed by a technician in the next room as the computers collected diagnostic data. It was difficult to fall asleep, but apparently I did sleep long enough and deep enough to collect data that showed that I had moderate sleep apnea and had stopped breathing hundreds of times during the night! I met with my sleep doctor the next week for official results and an overnight CPAP sleep apnea titration study was scheduled to determine the optimal CPAC (Continuous Positive Airway Pressure) air pressure and mask setting. My titration experience was similar to the original sleep study, however this time, throughout the night, the technician made adjustments to the air pressure needed to keep my throat open. She also tried different styles and sizes of masks.
For me, it took about three months to become relatively comfortable sleeping in a CPAC mask. I had been a stomach sleep and I learned to be a side sleeper. If you sleep with your mouth open you will likely need a full face mask. Fortunately, my sleep test showed that I don’t generally breath with my mouth open, so my specialist recommended a mask that just covered my nose. I hated that mask (and the mark it left on my nose). I tried a few more nasal masks and eventually found a comfortable, light weight nasal pillow mask that is inserted into my nostrils and doesn’t cover my nose. Everyone I know who has sleep apnea has tried at least three masks to find one that they can tolerate. I tried five. (Four at my own cost.) Even if your insurance won’t cover trying various masks, it’s worth the cost to find a mask style that you can live with. Experiment with different sizes of masks, nasal pillows, and head straps. Not only do I have a narrow airway, I also have a small nose and head so it was important to find the right fit.
If you are a singer, a heated hose and humidifier is absolutely essential! On the plus side, breathing warm humidified air every night has virtually eliminated my frequent sinus congestion and sinus infections. Caution: Be sure to keep the equipment clean and sanitary so that you aren’t inhaling bacteria or (yuk) mold!
I can honestly say that I haven’t skipped a single night of using my CPAC machine. Some people refuse to consistently use their CPAP equipment even after diagnosis, which is why insurance companies frequently pay to rent the equipment for the first few months, rather than cover the full cost of the CPAC machine and mask. Without insurance, a CPAC machine will cost about $1000 out of pocket. If your specialist has recommended a BIPAP (Bilevel Positive Airway Pressure) machine, they can cost several thousand dollars.
Is it worth the hassle of going through all of the sleep studies, finding the right mask, and wearing something on your face that looks like the monster from Alien? Is it worth traveling with “Grace” and having to buy distilled water for my CPAC everywhere I go? Yes. I wake rested and don’t have brain fog (except the occasional menopause brain fog but that’s a different article). My overall health is better, my vocal range and breath stamina have improved, and my husband says my sleep mask is sexier than my snoring. More importantly, I am far less likely to stop breathing and die in my sleep.
Whether you are a singer or not, If you have any symptoms of sleep apnea, I urge you to have that uncomfortable conversation with your primary care physician and request a referral to a sleep specialist. It’s a game changer.
More information from the Mayo Clinic:
“Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night’s sleep, you might have sleep apnea.
The main types of sleep apnea are:
Obstructive sleep apnea, the more common form that occurs when throat muscles relax
Central sleep apnea, which occurs when your brain doesn’t send proper signals to the muscles that control breathing
Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, which occurs when someone has both obstructive sleep apnea and central sleep apnea
If you think you might have sleep apnea, see your doctor. Treatment can ease your symptoms and might help prevent heart problems and other complications.”- https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631
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