Veterans plagued with sleep problems

Joseph Arsenault of Bernardston displays the CPAP breathing machine he wears to help with his sleep apnea. Gazette Staff/Sarah Crosby

By LISA SPEAR | For The Recorder | Monday, January 16, 2017 – Recorder.com

Air Force veteran John Paradis’ snoring stutters like a chainsaw before he stops breathing.
Paradis, 53, of Northampton gasps for air, choking back to consciousness after his airways collapse over and over again throughout the night. He is fighting to get a full night’s rest because he suffers from obstructive sleep apnea, a condition that stops his breathing more than 30 times every night. He wakes up and tosses and turns, until he rises groggy in the morning.

“You shouldn’t have to live this way. It’s not normal to not get a full night of sleep,” Paradis said.

Plagued with sleep problems since he returned from military duty in Iraq 12 years ago, Paradis finally received a diagnosis a month ago and is about to be fitted with an overnight breathing machine that is expected to relieve his symptoms.

Through his work in community relations and outreach at the U.S. Veterans Affairs health center in Bedford, Paradis says he has met many other veterans who have similar restless nights.

“It is compelling to me — the amount of veterans that I interact with who tell me that they have sleep disorders, too,” he said. “There has to be something there.”

Numbers growing
He seems to be right. Sleep apnea — a serious sleep disorder in which breathing stops and starts during the night — is a condition four times more common among veterans than the general population, according to the National Sleep Foundation. While about 5 percent of the people in the United States have sleep apnea, up to 20 percent of veterans suffer from it, the foundation says. A study released last February from Stanford University found that 87 percent of veterans between the ages of 55 and 89 have the condition.

The number of veterans receiving disability benefits for sleep apnea is soaring, and has more than doubled in the last four years, according to data from the Department of Veterans Affairs. In western and central Massachusetts about 40 veterans are diagnosed with sleep apnea each month and that number has steadily increased over the past year.

There are two basic types of sleep apnea, obstructive, the most common, in which the airways are blocked when the muscles in the back of the throat relax during sleep, and central sleep apnea in which the brain fails to signal the muscles to breathe.

While the reason for the higher incidence among veterans remains a mystery, some in the medical community, including doctors at Yale School of Medicine who issued a report in 2014, believe there may be a correlation between the stressors of war and the high vigilance that comes with PTSD (post-traumatic stress disorder).

Some veterans wonder if environmental factors, like inhaling the dust from sandstorms in Iraq or the smoke from trash burn pits in Afghanistan caused their condition, though doctors doubt the connection.

Seth Kupferschmid, the chief of staff at the Veterans Administration of Central Western Massachusetts believes one reason for the increase in diagnoses is that more veterans are being tested for it. Age, he believes is another factor.

“We have a population that is getting older so they are more likely to develop sleep apnea, and like the general population, some of our veterans are overweight so that contributes to it.”

Seeking relief
Paradis, who is now retired from the military, is not overweight. He is slim, active and lives a healthy lifestyle. And, he says, he was just in his early 40s when he returned home from Iraq and found himself feeling tired all the time.

“I’m tired, I’m exhausted every day,” he said. “It’s kind of like my new normal.”

As a result, Paradis says, he is unable to concentrate and his snoring — a sign of sleep apnea — has disturbed his wife, Denise Paradis’ sleep and caused friction with his two college-age children. Over the years, he says, he has made numerous lifestyle changes: He’s avoided caffeine and alcohol, gone for a run before bedtime, meditated before going to sleep. Nothing helped.

Finally, a friend’s suggestion that he might have sleep apnea, led him to seek a doctor’s help. The diagnosis came after a take-home sleep study using a kit provided to record his snoring and heartbeat and monitor when he stops breathing. Now he is waiting to be fitted for a CPAP (continuous positive airway pressure) machine — a mask attached to an oxygen source, which he will wear to bed each night.

Iraq war Army veteran, Joseph Arsenault, 30, of Bernardston, began using a CPAP machine after he was diagnosed with sleep apnea five years ago. He says he noticed a difference the first time he tried it.

“That was probably the first real night of sleep I had in a while,” said Arsenault, who works as the housekeeping supervisor at the VA medical center in Leeds.

Like Paradis, he says, he noticed feeling tired all of the time after his return from Iraq. His wife’s complaints about his snoring led him to consult his doctor. “I had never even heard of sleep apnea before.”

While the sleep machine — the common treatment for sleep apnea — helped him, he, like other patients found it uncomfortable at first. The tube connected to his mask, he says prevented him from rolling over when trying to fall asleep. With time, however, he got used to it and now wears the mask every night.

Hard to adjust
Another war veteran, Leigh Paz, 37, of West Springfield, who also works at the VA medical center in Leeds, hasn’t been so lucky. He says that wearing the device feels like he has an octopus on his head. If he is able to fall asleep with it on, he says, he usually removes it in his sleep.

“It’s claustrophobic. It’s just like air blasting. There is nothing fun about it,” he said. “If feels like you are sticking your head out a car window while driving 20 mph.”

Dr. Neil Bach, a sleep medicine staff physician at Baystate Medical Center in Springfield, says there are different types of CPAP machines and individuals may find the comfort level varies. For instance, some machines will continuously pump air into the nose and mouth while others will monitor the person’s breathing and only kick in when it stops. The machine also automatically adjusts the air pressure to suit the individual, he said.

But for someone with sleep apnea, Bach says, using a CPAP is worth the effort of trying to adjust to it.

When the patient gasps for air, he says, there is a surge of adrenaline that spurs inflammation in the body that could lead to a variety of diseases: high blood pressure, heart failure, diabetes, psoriasis. “There is no bigger yield in medicine than treating sleep apnea,” Bach said.

Like Paradis and Arsenault, Paz said he began noticing extreme exhaustion after he returned home from duty in Iraq.

He says he usually can’t make it from his home to his job in Leeds without his eyes getting heavy. He often has to pull over to take power naps.

He says he doesn’t have the energy to go to the gym, and he finds it hard to concentrate at his job as a patient advocate.

“I do know that it takes away from the quality of your life,” he said. “You wake up in the morning and you should feel like you could conquer the world, but instead you feel like you got hit by a bus.”

Service-related or not?
Though the veterans interviewed are convinced their sleep issues are related to their military service, in at least two of the cases, the VA doesn’t agree. Both Arsenault and Paz have been turned down for disability benefits. Paradis is in the process of applying.

None had a sleep study done until after his discharge.

“If you don’t get a sleep study while still in the military, then it is harder to prove that it is connected to the military,” Paz said. He has applied for benefits several times — which could entitle him up to $838 per month for the rest of his life, he says — but has been rejected each time. “To me, it is kind of unfair.” While in a war zone, sleep problems are rarely on a soldier’s mind, he says.

The concern is more about the rockets raining from the sky or exploding land mines — basic survival, Paz says. Sleep is usually an after thought.

“Chances are they are not going to send me to do a sleep study in Iraq,” he said. “They’ve got bigger and better things to worry about, like guys coming up with amputations and being blown up.”

Arsenault says he suffers from PTSD and recalls having sleep problems when he was in Iraq, but, the lack of a sleep study back then also has resulted in his application for benefits being rejected. “I tried, but there is no record of it when I was in service,” he said. “Basically, they are saying that (sleep apnea) happened to me after I got out.”

He says that through his job at the VA, he has come across a large number of veterans who suffer from sleep apnea. Some get benefits, some don’t. Kupferschmid, the chief of staff at the Veterans Administration of Central Western Massachusetts, declined to comment on why that is.

Part of Paz’s job is to help other veterans understand their entitlements. He advises veterans who snore to get sleep studies done regardless of whether or not the VA will consider a sleep apnea diagnosis a service-related disability.

“I see veterans in good shape who shouldn’t have sleep apnea, but do,” he said.

“Could it be from PTSD? Could it be from the sand storms? Could it be from the burn pits? I think no one really knows, but the hard part is that I wasn’t like this before and I am like this now.”