It was a hot summer night in 1980, and the 45-year-old Australian builder was so exhausted he was nearly falling off scaffolding. He had sleep apnea — a condition that causes people to struggle to breathe while sleeping — and his body was barely holding itself together due to a severe lack of quality sleep. Finally his doctors told him that he had a choice: Either punch a hole in his throat so he could breathe while sleeping, a procedure known as a tracheotomy, or become a test subject for a new machine called a CPAP, short for continuous positive airway pressure.
“I don’t think the significance of sleep apnea is still fully grasped often by the medical profession.”
The builder chose the CPAP, and from July 8 to 9, 1980, he took a literally historic snooze. When the builder woke up the following morning, he remarked at how refreshed he felt. For the first time he could remember, he felt genuinely awake and well-rested. His brain fog had dissipated; his blood pressure had improved; and, perhaps most strikingly, he realized he had been rendered partially color blind from exhaustion. One thing he did not recall, however, was how he wound up in the room with the CPAP in the first place. It is a somewhat cruel ironic twist: The first person to ever sleep with a CPAP was so desperately tired when he agreed to wear it that he did not remember doing so the following morning. He even asked where he was because his brain had not recorded memories of his own pioneering slumber.
By contrast, I clearly remember my first experience wearing a CPAP. As a sleep apnea patient, I compare the sensation of wearing a CPAP to being embraced by the facehugger from Ridley Scott’s 1979 film “Alien.” Instead of impregnating a human host with a xenomorph, the CPAP releases a stream of positive air into the person’s trachea.
While there are several possible designs, all CPAPs strap around a person’s face in some capacity to force a mask over their nose (or nose and mouth) to blow an appropriately pressurized air stream into their tracheas as they breathe. The sensation is extremely unnatural and unpleasant, but I prefer sleeping with that discomfort over being so tired that I have to squeeze naps into my day like a dehydrated man gulping water.
When I shared my “Alien” analogy with Dr. Colin Sullivan, he laughed and empathized. Sullivan is the inventor of the CPAP, and he was the doctor leading the test on his hapless fellow Australian, the exhausted 45-year-old builder. Perhaps unlike other inventors, who might wish for their creations to last until the ends of time, Sullivan — despite using a CPAP himself for his own snoring — admitted that he wishes for a day when CPAPs will no longer need to be used.
80% of people who use CPAPs regularly report significant improvements in their sleep apnea symptoms.
That day may not seem anywhere close. As of last year, the American Medical Association estimates that roughly 30 million Americans have sleep apnea, although only 6 million are currently diagnosed with the condition. Millions who suffer from daytime sleepiness have sleep apnea and simply do not realize it, either because they sleep alone or those who hear their sleep dismiss it as “harmless” snoring. Indeed, sleep apnea may be yet another of the great undiagnosed epidemics: Virtually anyone who snores is at the very least on the spectrum for sleep apnea, as Sullivan pointed out.
What’s more, as obesity rates continue to soar, our cramped necks will increasingly struggle to keep us breathing while we sleep. Sleep apnea, whether caused by obstructions, aging or anatomical problems, is more than an inconvenience; people with apnea are at a high risk of elevated blood pressure, heart disease, diabetes, Alzheimer’s disease, strokes and a number of mental illnesses.
The good news is that, according to a 2014 study in the European Respiratory Journal, 80% of people who use CPAPs regularly report significant improvements in their sleep apnea symptoms. The bad news is that a lot of people — particularly those with claustrophobia or other mental illnesses — view the prospect of wearing that CPAP with about as much trepidation as they might an actual facehugger.
Want more health and science stories in your inbox? Subscribe to Salon’s weekly newsletter Lab Notes.
“I can remember some of our early patients who literally could not stay awake, even during the day, even when we were studying them and asked them to stay awake.”
It is a problem that Sullivan admits bedevils him to this day, although he also notes that CPAPs have evolved over the years to become much more comfortable than during his 1980 experiment. That primitive CPAP, as I witnessed myself, looked like two giant hoses connected to a clunky apparatus that was secured over the man’s nose with tape. A hat with still more tape further held the device in place, and the patient had a netting wrapped around his mid-torso to keep it steady as well.
By contrast, even today’s clunkiest CPAP looks like a walk in the park. Yet there is a good reason why patients like the 45-year-old Australian builder were willing to try the bulkier, more intimidating CPAPs. As explained by Sullivan’s mentor, Dr. Eliot A. Phillipson of the University of Toronto, “when the science community first started to become aware of this syndrome, and to understand it, it was in the mid-1970s and all of the patients that were studied had severe daytime sleepiness.”
Specific examples stood out in his memory. “I can remember some of our early patients who literally could not stay awake, even during the day, even when we were studying them and asked them to stay awake,” Phillipson told Salon. “I can remember at least two police officers that were referred to me. And when they were on night shift and sitting in a patrol car, supposedly observing, some action or some activity, they couldn’t stay awake.”
When Sullivan left his work with Phillipson in 1979 and moved to the University of Sydney in 1980, he continued his mentor’s interest in learning about upper respiratory ailments. They had begun by studying SIDS, or sudden infant death syndrome, and had theorized that it might be caused by the infants literally being unable to breathe while they slept. As Sullivan’s interests progressed to sleep apnea more broadly, he found himself wondering why people of all ages who struggled with breathing while they slept couldn’t be helped with a little positive airway pressure into their tracheas.
While Sullivan hopes for a future in which CPAPs are unnecessary, the first step is for the medical profession to fully recognize the prevalence and seriousness of sleep apnea.
He felt this technique would be far less disruptive to the person’s life than either constantly being tired during the day or, as a last resort, punching a hole in their throat with a tracheotomy. At the same time, Sullivan emphasized that CPAPs were always intended to be a temporary physical therapy measure, not a permanent solution.
“I’ve spent a lot of half my career looking at pediatric sleep apnea, sleep disorder breathing, and I do think that trying to intervene early, identifying kids who have the risk factors, gives us a chance of preventing it,” Sullivan explained. “There’s no doubt that the size and shape of the upper airway is important. Some orthodontic procedures actually can be very effective. And I think if we can identify earlier, we have a chance of preventing it.”
He also added that there are oral devices which, for some individuals, are quite effective, as well as various drugs — although unlike drugs, CPAPs are extremely safe and don’t have side effects like being “Ambientoxicated.” And while Sullivan hopes for a future in which CPAPs are unnecessary, the first step is for the medical profession to fully recognize the prevalence and seriousness of sleep apnea.
“I don’t think the significance of sleep apnea is still fully grasped often by the medical profession,” Sullivan told Salon. “One of the issues that I’ve become aware of is that I think snoring and sleep apnea put you at risk of getting a number of diseases. I still am astounded when I see patients who have got various cardiac conditions and no one’s really looked at or even asked them about what happens to them at nighttime in terms of sleep.”
He also encourages patients to lose weight, as doing so can at least relieve sleep apnea symptoms if not entirely eliminate them. He also hopes that weight loss drugs like Ozempic could reduce the prevalence of apnea, although he added that not all apnea cases are linked to weight. When asked if he thinks snoring more generally is always a sign of sleep disorders, Sullivan agreed without hesitation.
“That is absolutely correct,” Sullivan told Salon. “Snoring is a forerunner for so many people, probably the majority, and I think that a very large number of patients I’ve seen, it’s a typical story that they were okay and they started snoring at 30 or 35 or whatever, and then it kept going, and then they developed apnea after 10 years, nine years, etc. And I think snoring isn’t good for you. It damages the airway, it interrupts your sleep, just like sleep apnea does. It’s part of the same spectrum.”
If you snore or have apnea and wish to break out of that cycle, the CPAP exists as a medical appliance that can change your life. It was innovated as a superior alternative to a life-altering surgery or continuing to live with a debilitating condition — but at the same time “from the beginning. I initially saw this therapy as a rescue therapy,” Sullivan explained. “We and others were all trying to see if we could get a surgical solution by removing tissue from the upper airway. And certainly that can happen in some people, but that’s sort of a big deal.”
about the science of sleep: