A Quiet Killer Among Us
by ResMed Chief Medical Officer, Carlos M. Nunez, M.D.
"Sleep is itself a necessary pillar of good health."

September 7, 2017

We are staring down the barrel of a public health crisis with potentially catastrophic consequences. There is a silent menace that is staggeringly under diagnosed, leaving those impacted too often in the dark about their health, and therefore unable to get the care they need.

As a physician, I am keenly aware of both the present need and important opportunity to share this vital message that may help patients avoid potentially deadly health problems. There is a common healthcare thread in several terrible widely-reported tragedies in recent years – including two fatal train crashes in the New York metro area, a fatal vehicular accident in which actor Tracy Morgan was critically injured, and just recently Carrie Fisher’s death. I passionately believe there is a way to transform such devastating events into a critically important learning opportunity for the millions of people who unknowingly may face a similar, serious health concern: chronic sleep disorders.

Sufficient, quality sleep is itself a necessary pillar of good health. Conversely, insufficient sleep is associated with myriad chronic diseases and conditions, along with dangerous and oftentimes fatal occupational accidents and errors. According to the Centers for Disease Control, Americans today get fewer than seven hours of sleep per night. This is a very real threat to our nation’s health and safety.

The impact

The Institute of Medicine estimates that 50 to 70 million Americans suffer from a chronic sleep disorder.1 Sleep apnea is one key contributor to insufficient sleep – approximately 25 percent of adults have this disorder,2 and 85 percent of cases are undiagnosed.3 It is a potentially fatal condition with harmful short- and long-term complications that can be life threatening,4 and research has shown it is quite common, affecting more than one-in-three men and one-in-six women.5 Beyond health, there is also a tremendous associated financial impact. In 2015 alone, undiagnosed sleep apnea cost the U.S. nearly $150 billion, as a result of related lost productivity, motor vehicle accidents and workplace accidents, as well as healthcare costs and medications prescribed to treat conditions associated with sleep apnea.6

Yet, despite such gravity and prevalence, sleep apnea is a condition that has remained poorly understood and often overlooked by the general population, as well as many of my peers within the healthcare community. Each of the tragedies mentioned above are connected by this particular sleep disorder, the most common being obstructive sleep apnea (OSA). Sleep apnea fundamentally causes your body to stop breathing while you sleep. This results in less oxygen getting to both your brain and bloodstream, the health implications of which can be quite severe. In some cases, apnea can occur more than 100 times per hour – without the affected person ever realizing this is happening.

Sleep apnea can lead to other diseases

It can feel challenging to be aware of what our bodies do when we are sleeping. But sleep apnea often does present itself in other ways to which we may already be more attuned. At a minimum, the constant disruption of sleep due to apnea can result in feeling fatigued or unfocused during the day, or cause other symptoms like headaches. Over time, sleep apnea can lead to hypertension, diminished blood glucose response, heart disease and other issues. When any of these or other symptoms is present, sleep disorders need to be considered and potentially assessed to determine if apnea is occurring, so it can be properly treated.

Patient exams and medical histories routinely include questions linked to cancer, cardiovascular health and other important diseases, along with lifestyle factors including physical activity and diet. Unfortunately, sleep is quite often overlooked. I have experienced this myself as a patient, when during my most recent annual check-up that covered many diseases, signs and symptoms, my own doctor didn’t ask me a single question about my sleep. As long as sleep apnea remains overlooked, its related – and dire – health consequences cannot be adequately addressed.

What we can do

We have our work cut out for us. At the heart of our charge at hand is encouraging more widespread education to correct common misunderstandings about chronic insufficient sleep and how it can contribute to several serious health problems, and increase mortality.

In my various professional and personal roles, my duty remains the same. As a physician, in my career at ResMed, as a patient myself, and among my family and friends, I am relentlessly dedicated to the mission of improving others’ lives by raising awareness about the importance of healthy sleep and breathing, minimizing roadblocks that may inhibit the diagnoses of sleep and breathing-related disorders, especially sleep apnea, and ensuring it becomes a more widely recognized and understood condition.

We must appreciate the biological importance of sleep. We must recognize the signs and symptoms and risk factors associated with sleep apnea. We must foster and encourage regular discourse about sleep and sleep apnea between patients and their healthcare providers. We must remember there are treatment options available for those impacted. Encouragingly, effective diagnostic and treatment tools and methods are already available. But in order for susceptible patients to receive such care, a collective effort is required to change the course of awareness and frequency of testing.

Now is the time for healthcare professionals, companies, legislators, advocacy groups and regulatory agencies to find new ways to partner together to improve comprehensive education about this important topic, and ensure it is addressed like any other serious disease. It is essential that healthcare professionals and patients alike become armed with the information they need to ask simple yet necessary questions required to assess – and address – individual risk of chronic insufficient sleep. We must work together to make a measurable difference.

Our health and our lives depend on it.


1. Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. Available from: https://www.ncbi.nlm.nih.gov/books/NBK19960/. doi: 10.17226/11617

2. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased Prevalence of Sleep-Disordered Breathing in Adults. American Journal of Epidemiology. 2013;177(9):1006-1014. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3639722/. doi:10.1093/aje/kws342.

3. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20:705–6. doi: 10.1093/sleep/20.9.705.

4. Luyster FS, Strollo PJ, Zee PC, Walsh JK on behalf of the Boards of Directors of the American Academy of Sleep Medicine and the Sleep Research Society. Sleep: A Health Imperative. Sleep. 2012;35(6):727-734. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353049/#B3. doi:10.5665/sleep.1846.

5. Peppard PE et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–14.

6. Frost & Sullivan, on behalf of the American Academy of Sleep Medicine (AASM). Hidden Health Crisis Costing American Billions: Underdiagnosing and Undertreating Obstructive Sleep Apnea Draining Healthcare System. www.AASMnet.org. 2016: 4. Available from: http://www.aasmnet.org/Resources/pdf/sleep-apnea-economic-crisis.pdf.

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