Page last updated at 13:17 GMT, Wednesday, 17 March 2010

Scrubbing Up: sleeping killers

In this week's Scrubbing Up, obesity expert Professor Tony Leeds warns that our weight problems could also put the lives of other people at risk.

What do you think? Here are some of the comments you have been sending in to this week's Scrubbing Up .


Once again when it comes to OSA someone drags out the 'fat boy syndrome' and blames the sufferer. Let me just say, yes there is a relationship between OSA and weight, but it is not just a one way casual one. Sleep apnoea in itself and the disruption of meaningful sleep plays havoc with the body's blood chemistry and metabolism and causes weight gain. This can lead to an upward spiral of progressively worse OSA. For more than 50 years my weight was never over nine and half stone. In the last five years since I had a sleep problem I have put on over three stone. Last year I was finally diagnosed with OSA. The treatment for this is CPAP - Continous Positive Airway Pressure. Once proper treatment has started weight starts to come down for a lot of patients . CPAP is the gold standard treatment for severe OSA according to NICE guidlines. My consultant and my GP have recommended I have this treatment. Although I stop breathing more than 40 times an hour, here in Cardiff I have been refused any sort of CPAP treatment by the Health Commission Wales purely on the grounds of financial expediency. Some people have a throat structure that predisposes them to OSA. Losing weight is not going to cure my OSA. What is the point of publishing articles like this if a proven and effective treatment for OSA is just not made available. All this will do is prevent people from seeking help if they suspect they have a problem for fear of losing their driving licence. In these days who is going to risk possibly losing their job because their Health Authority may not fund the treatment that can allow them to live a normal life?
John Whale, Cardiff

It is interesting to see this appear on the same day that there is debate about GPs being overburdened with people with minor ailments. When I referred for tiredness in the past it was put down to my lifestyle generally and probably viewed as such timewasting. My sleep apnoea was only diagnosed after getting floppy eyelid syndrome resulting from the apnoea. Surgery corrected the eye problem but as a result my sleep apnoea was formally diagnosed. I can confirm what others say about the CPAP treatment, it is life transforming. Whilst professional drivers are indeed a concern, they are the least likely to raise the issue with their GP because a diagnosis has to be referred to the DVLA and your licence put at risk. A change to that process might well see more of them seeking diagnosis.
Phillip Holley, Cambs, UK

I am under CPAP treatment for severe sleep apnoea, a condition which has made me fall asleep before TV and at boring meetings, but I have never fallen asleep behind the wheel. On the contrary, I am a very alert and awake driver. Since childhood I have slept during school hours and boring meetings, but I always thought it was a fault of mine, and people got angry at me. I had no difficulty in learning and passing exams, and performing my job. I have large tonsils that are a major part of the problem. As to obesity vs sleep apnoea, the Danish experts tell me that obesity may be the result of the sleep apnoea condition rather than the opposite, as sleep apnoea patients tend to eat snacks during the day to keep awake. Moreover sleeping too little makes the body produce unhealthy stress hormones that also make the person obese. Currently they are doing research on this in Denmark, as they also believe unhealthy sleep patterns of teenagers make them obese. Their viewpoint is that because of the two above factors, it is almost impossible to lose weight if the condition is untreated. That is why they start CPAP treatment before they recommend losing weight. So what comes first - the chicken or the egg?
L. Wendt, Faaborg, Denmark

I think the professor overstates his case. We live in a sleep-deprived society - it's not only the obese who have sleep problems. Most of us spend too much time awake and many are too stressed to get proper sleep. But of course, it's far simpler to go for the easy targets than to suggest social change. Also, could there not be some confusion between what is the cause and effect here? Some studies seem to suggest that lack of sleep can contribute to endocrine imbalance, putting on weight and diabetes. Yeah, and while we're about let's blame fat lorry drivers, shall we? Rather than the companies that make them drive at all hours and the economic circumstances that obliges them to comply in order to eke out a living.
MP Hoskins, Herts, UK

My wife with type 2 diabetes also has sleep apnoea, as tested in a sleep lab. But the only thing they can do for her is to prescribe a large noisy machine with an uncomfortable mask she has to wear while asleep. So she stopped using it. Luckily, she doesn't drive much and she naps in the afternoon. The medics ought to come up with some better form of treatment.
Robert Jaffe, Vero Beach, USA

I confess that I have fallen asleep at the wheel. Unlike the people described in this article I'm very athletic, but fell victim to odd hours and strenuous work. I had to drive forty minutes to work, thirty minutes of it on the highway. On my way home one afternoon I fell asleep and rolled my car over. Since then, if I am at all tired I pull over and take a nap.
Joseph Kill, USA

I was diagnosed with sleep apnoea two years ago. It was only when my husband told me I stopped breathing in my sleep that I went to the doctors. He referred me to Papworth hospital where I had tests done. That is when it was confirmed. I was put onto CPAP and put forward for a gastric bypass. Two years later I have had the operation, lost six and a half stone to date and the sleep apnoea has now gone. I had never heard of this condition before and I'm sure a lot of other people haven't either. I think the condition should be made more known and maybe motorists would realise and get checked out. This could make the roads safer in the future.
Tina Riach, Chatteris, Cambs, UK

I was diagnosed with OSA in May 2008. I am a HGV driver but I'm not overweight and eat healthily. I've been on CPAP therapy since my diagnosis, I have to have a yearly medical for the DVLA and a yearly review clinic at the Brompton, who are excellent. I have been off work due to my OSA for three weeks but will not be back at work for at least another two weeks. A lot of the problem I believe is a lack of awareness, by people in general and GPs. Some people are diagnosed and can't even get CPAP or have to wait months for sleep studies or treatment.
Peter Tomlinson, Redbourn, Herts, UK

I have OSA and I wear a mask at night to 'cure' it. I'm still tired during the day and my sleep is even more disturbed now. I'm obese and have type 2 diabetes. The main problem with the mask is that if it doesn't fit properly first time then it doesn't fit all night so I'm constantly adjusting it whilst I'm trying to sleep so therefore suffer from even more disturbed sleep.
Steve Farndale, Peterborough, UK

Lorry drivers should be tested for this when they have their driver's medical exam. In Ontario, Canada this is mandatory every three years. With doctors held liable if they do not report medical conditions which would preclude driving a commercial vehicle. Failure to pass the medical means your license is reduced to the lowest class which precludes lorry driving. This exam should be extended to all drivers instead of allowing self reporting as is now the case in Britain. You'd be amazed at the number of banned drivers.
Kathleen Boden, Lincoln, UK

I've had OSA since 1988, though at that time I wasn't aware of it. Back in 1989 I was involved in five accidents in three months. In one of them I was rear-ended, which couldn't be down to OSA. The others, well...looking back I'd say that possibly a small decrease in concentration could have been to blame - in none of the accidents was I blamed by the police! Today, my OSA is extreme, and I wouldn't drive, I just wouldn't be safe. My concentration is gone, I'm constantly tired and my memory is terrible. No one with OSA is fit to drive. Incidentally, when I first saw my GP about stopping breathing whilst sleeping, he diagnosed Alzheimers! It wasn't until I had a girlfriend who was a nurse that I found out that I had apnoea. I use a CPAP breathing machine which may help me to keep breathing during sleep, but I am still constantly tired. As far as I know, the only treatment offered for OSA is a CPAP machine - there used to be an operation, under the NHS, which relieved the illness, but it has now been stopped!
Joe, Alexandria, UK

I first realised something was wrong with me when I fell asleep on the M4 and woke up underneath the tailgate of a lorry. Luckily I woke up before impact but it scared me enough to go to my doctor and he suggested I should go to the Oxford sleep clinic for a overnight test for sleep apneoa. What drivers must appreciate is that until something like this happens they haven't a clue that anything is wrong. But it could have easily been fatal for me or worse some innocent on the road at the wrong time. Most cases can be cured when diagnosed, by careful diet and a change of food type. In the meantime the sleep apnoea clinic supplies a night breathing unit to give you a good night's sleep. This has changed my life. I was so impressed with their work that I joined the committee to help them promote awareness of this dangerous ailment predominantly brought on by obesity. Fleet operators, company employers who drive for their firms, taxi drivers, bus drivers and all groups of commercial drivers should have compulsory yearly checks by the company doctor or their own GP for signs of seep apnoea.
Michael A.E.Moseley, Windsor, Berkshire, UK

Back in 2007, I was going through a bad patch and comfort ate as a way of dealing with stress. As a result, my weight ballooned. I knew I was snoring at night, as in the end I decided than rather face repeated digs in the back, it was better to sleep on the sofa. I was always constantly tired, but I never realised how bad I was. At work, I thought I was just closing my eyes, but it wasn't until my manager pointed out that I was often asleep for more than 10 minutes at a time that I realised it was serious. A sleep study showed me that where the normal person would wake up briefly about nine times a night - although they wouldn't know it - I was waking up 60 times an hour. In other words, for the best part of a year, I had not slept properly, only dozed. I was lucky in several ways. Firstly that my bosses were very understanding - they wrote a letter to my doctor so that it could be taken seriously and let me have six months off paid to get myself sorted out. I could easily have been sacked. Secondly, as it was a 70 mile round trip to work up and down the motorway, I was extremely lucky not to have caused any accidents. I came close to dozing off behind a wheel no end of times. Nowadays I am receiving treatment in the form of a CPAP machine that stops my airway from closing up at night, so I can go into the deep sleep I need. Whereas before I would try and sleep for about 10 hours and still feel exhausted, I can go with about four to five hours and feel a lot fresher. I urge anyone who constantly feels tired despite getting sleep to get themselves checked out - particularly if you are a heavy snorer or have a large neck size.
Stephen Buxton, Coventry

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