An Unexpected Condition
Especially when you're young, sleep apnea can kill you. When old, it can really muck up your life.
And American and Canadian police appear to suffer sleep apnea in epidemic numbers.
That's not the conclusion reached by media reports on an important Harvard study on 5000 American and Canadian police. Media reports declared a third of the police "had" sleep apnea.
True - if you diagnose sleep apnea by self-reported questionnaire. But no sleep clinician does that. Many people describing "severe" symptoms will not have apnea, while those with few or no symptoms may suffer severe disease.
Which is what the Harvard study actually found - a very high rate of apnea among the police least expected to experience it.
When you stop breathing you're experiencing an apnea. They occur during wakefulness but are particularly common in sleep. Apnea rates increase with age and size - though young, rail thin kids can have severe apnea - another reason formal sleep testing is required to diagnose it.
Apneas are clinically defined as episodes of at least 10 seconds where air flow decreases more than 80%; hypopneas are the same except that airflow is 50-80% of normal. The two are generally lumped together as the apnea-hypopnea index in part because the clinical problems they provoke tend to be very close; much of the damage of apneas comes from people waking up when they stop breathing.
Not that they remember waking. You usually need to be awake several minutes to remember being awake - so many apnea sufferers have no idea they've got a problem.
Mild sleep apnea is defined as 5-15 apneas and hypopneas an hour; moderate is 15-30; severe is over 30. Most of us will have one or two apneas an hour as we mature into adulthood.
Which brings us to the police.
Apneas All Over the Place
Doing large population studies is expensive and difficult. The Harvard researchers started with questionnaires filled out by municipal and state police. By questionnaire 36% of municipal police were suspected to have significant apneas; only 20.3% of the Massachusetts State Police. Dr. Charles Czeisler, chief of sleep medicine at Harvard and last author of the study, noted that the Massachusetts State Police were in better shape than other groups in part because they are required to pass a physical fitness test each year. They also weighed considerably less - increased weight is a major risk factor for sleep apnea.
Excellent clinicians that they are, the Harvard researchers decided to look at real apnea rates among the police. One hundred twenty six Massachusetts State Police underwent formal sleep testing - 63 defined by questionnaire as not having clinical apnea, 63 with.
Remember - by questionnaire this was the "healthiest" group of police, with suspected apnea rates of only 20%.
So let's look at this healthy group - and those by questionnaire thought not to have sleep apnea.
46.7% had more than 10 apneas and hypopneas per hour.
Now, first, recognize that this is the healthiest group - Massachusetts State Police already screened as not having clinical sleep apnea. When you do proper testing, nearly half have more than 10 per hour - when the diagnostic definition is only 5 or more per hour.
And fully 18.3% had more than 25 apneas and hypopneas per hour - meaning many of them had severe apneas - though by questionnaire they were thought to be fine.
As for those thought to have apnea by questionnaire - approximately a fifth of the Massachusetts State Police - 81.5% had more than 10 per hour, with nearly 43% in the severe range.
You can draw two quick conclusions: 1. Questionnaires do gauge severity but don't properly diagnose sleep apnea 2. If in the healthiest group, already prescreened to not to have sleep apnea, half show up with 10 or more per hour, then North American police have a really big sleep apnea problem.
Sleep and Public Safety
The Harvard Study also demonstrated an epidemic of sleepiness among the police. Over half reported falling asleep at the wheel on the job. Many made administrative mistakes - especially among the 40% calculated to have a "sleep disorder." For those who did, other clinical problems were particularly common. Using complex statistical modeling, those who had "sleep disorder" had 2.1 times the rate of depression, 2.8 times the sense of feeling burned out, and 1.62 times the safety errors.
Yet by sleep testing, the rates of apnea are already far higher than the total number of questionnaire "sleep disorders."
Which helps explain that one third of police dying on the job experience fatal car crashes.
Why Should Police Have Such High Sleep Apnea Rates?
There are plenty of reasons for police to have multiple sleep disorders - particularly sleep apnea.
They're shiftworkers - often doing swing shifts. Shiftworkers blow up biological clocks, and have higher rates of obesity, cardiovascular disease, GI disturbance and depression - all of which are also associated with sleep apnea.
Police often do highly sedentary jobs - stuck at desks or inside squad cars. Fast food is sometimes the only food commercially available during working hours.
Police work is very stressful - which can also add weight, a big factor in causing sleep apnea.
What Should be Done?
Police are really sleepy - which is dangerous to them and us. Swing shifts are not good for people's health - particularly when there are many other possible shift work schedules.
Yet if you have a lot of sleep apnea - and other sleep problems - you should treat them.
Better, prevent them.
To find sleep apnea, you test for it. Once you know it's clinically present - especially if people are sleepy in the daytime - you can treat it with weight loss; CPAP - an air device; or dental devices.
Weight loss and fitness is the first priority - because that's how you can prevent many folks from getting sleep apnea in the first place. CPAP works very well, but is difficult for some; dental devices and other treatments are available, though they work less well.
Importantly, you do nothing to stigmatize police with sleep apnea - or sleepiness. Truck drivers stay from proper sleep testing because they don't want to lose their jobs.
We went our police to be healthy - and awake and alert.
Dr. Czeisler is right in emphasizing physical fitness for police. But that's only the first step - how people eat, rest, and socialize is also critical to their health.
And health - not after the fact health care - should be the goal. It's a lot easier treating a problem that never starts.