Mike Napoli: Human PSA for OSA
Despite obstructive sleep apnea (OSA) affecting up to one-third of the adult U.S. population, public awareness of this potentially life-threatening medical disorder is shockingly low. Our best statistics suggest that 80% of people suffering from the condition are as yet undiagnosed. Sometimes it takes a high-profile public figure to start a national dialogue, raise awareness, and recalibrate our understanding of a disease. AIDS had Arthur Ashe. Breast cancer has Angelina Jolie. Sleep apnea has hirsute hardballer Mike Napoli. But it took near-fatal health consequences for him to summon the courage to take the drastic steps needed to overcome this disease; his is a cautionary tale.
Currently, Napoli is a Cleveland Indian facing off against the Red Sox, the team that he won a World Series with in 2013, in the ALDS. The 34-year-old continues to chug along on an enviable professional career. He is the first to admit that he owes his productivity and longevity in the game, in part, to his willingness to take extreme measures to combat his OSA.
Striking Out at Night
In interviews, Napoli has said that he believes he has had sleep apnea for his entire professional career. Over time, his symptoms escalated to the point where he feared for his life. He admitted to leaving hotel room doors open during road trips out of fear that paramedics would need to enter to resuscitate him. Napoli had been aware for quite some time of his chronic habitual snoring, witnessed apneas, and episodes of gasping for air while sleeping, but as the years went on he began to experience daytime symptoms too. His fatigue and sleepiness interfered with his ability to pay attention during team meetings. During the Red Sox's epic 2013 season, the situation became so bad that the team reserved a room, hidden away in Fenway Park, where Napoli could nap during pre-game batting practice. Napoli eventually succumbed to one of the most dangerous consequences of OSA: uncontrollable episodes of dozing off while driving. Clearly, something radical needed to be done.
A Mother's Intuition
The tipping point in beginning to address the problem had been in 2007, when Napoli was with the Angels. After he shared a hotel room with his mother, who had come to Boston for a road game, she voiced serious concerns about his sleep breathing patterns. Napoli underwent a sleep apnea test that showed severe sleep apnea. First, one sleep doctor prescribed him CPAP, the gold standard treatment for the disorder, but struggled with the machine and was unable to keep the mask on all night. Another sleep doctor prescribed hypnotic medications to help him try to get used to the CPAP but this proved ineffective for the slugger. CPAP intolerance is not an uncommon problem: Long-term CPAP compliance has historically been about 40-50%, but newer Auto-CPAP machines are more tolerable by providing the lowest air pressure needed to keep the airway open throughout the night. BiPAP may also be a more comfortable alternative for some people struggling with higher air pressures. Napoli at one point also tried an oral appliance for sleep apnea, a retainer-like device that is worn in the mouth at night and attempts to open the upper airway by pulling the mandible forward. He failed this treatment as well.
When in Doubt, Cut it Out
By the 2014 season, OSA had Napoli on the ropes - he seriously contemplated retiring at the end of the season. But then he learned about the nuclear option: Maxillomandibular advancement surgery. Unlike most other surgeries for sleep apnea, including nasal surgeries like septoplasty (correction of a deviated septum) and the uvulopalatopharyngoplasty ("UPPP"), the "bimax" as it's known actually has a good track record in terms of scientifically-backed results for OSA improvement. However, the invasiveness of the surgery is extreme enough to make the toughest among us think twice. During the procedure, an oral maxillofacial surgeon breaks the upper and lower jaws, the maxillae and mandible respectively, and uses metal hardware to move them forward about a centimeter. This results in a significant improvement in the diameter of the posterior airway, which is too narrow in sleep apnea sufferers. Despite knowing the risks, Napoli decided to go for it and had the procedure done in Boston in 2015.
Sleep Apnea: Finally Put to Bed
He experienced the typical post-surgical course, including having to spend a few days in the intensive care unit after the procedure. He then had his jaw wired shut for six weeks and could only consume a liquid diet, losing 15 pounds along the way. Napoli has admitted to losing feeling in his mid-face, including his lips, teeth and the roof of his mouth, which is one of the most common side effects of the surgery. But he is unequivocally positive about the decision to have the bimax and attributes the surgery to rejuvenating his career. Napoli has told the media that, besides tremendous improvements in focus and energy, he began dreaming again after having REM-free sleep for over a decade. The absence of dreaming is not unusual in severe cases of OSA. Sleep apnea tends to be worse in REM sleep, which is when we experience vivid dreams. This is because muscle tone decreases in REM, acting as a natural safety mechanism that prevents us from acting out our dreams, leading to a more collapsible upper airway. During sleep studies, it is common to see a huge uptick in abnormal breathing events just as the patient enters a REM period. Eventually, the body essentially learns to avoid REM altogether but this takes its toll on memory and concentration, as REM is crucial for these cognitive processes. Shortly after the surgery, Napoli famously reported having crazy dreams about rollerskating through downtown Boston in tiny jean shorts. These days, his nights are probably filled with even crazier dreams of winning the World Series again, this time in a Cleveland uniform.
Joseph Krainin, M.D., FAASM is the founder of Singular Sleep, the world's first online sleep center. He is a Fellow of the American Academy of Sleep Medicine and board-certified in both sleep medicine and neurology. He has been practicing medicine for over 10 years.
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