The following series of e-mail letters was sent to me by a woman in Virginia who graciously gave me permission to reproduce them on The Sleep Site. Why is it important to share them with you? Because they illustrate all too vividly what severe, untreated sleep apnea can do to patients and their families.

Sleep apnea is a potentially dangerous condition. In the absence of effective treatment, it can kill people. However, it usually kills gradually, a bit at a time: with progressive complications and repeated intensive care unit admissions.

The following letters depict a tragedy that almost certainly could have been prevented by timely, appropriate outpatient care.

I really don't know where else to turn - my husband who is 69 years old and very overweight is having a problem with sleeping - about 5 years ago when he was in the hospital with dehydration and flu, he had an attack of apnea -stopped breathing and the doctors inserted a tube down his throat and put him in intensive care for three days which is the time he did not regain his facilities.

Everything seems to have gone well since then, he is still on high blood pressure medication, he had only one kidney - but other than this he seemed to be okay - now in the last two weeks he has gotten out of bed in the morning, come downstairs and falls asleep - most of the time while reading the paper, drinking coffee etc. He has fallen asleep on the toilet, on the side of the bed, etc.

Also he is experiencing a shortness of breath a lot - He used to snore before the apnea, but since then I have not heard him snore or gasp for breath while he is asleep. Right now it is 11:20am and he has already fallen asleep three times each with a length of over 30 minutes. Sometimes talks or is not aware of where he is when he awakes - I need help -doctor's appt is two weeks away.

Dear Dr Clark - With my thanks to you for your quick answer to my questions and for your honest reply that my husband should be in the emergency room - I took him last Tuesday to the emergency room and they admitted him to the hospital immediately - they thought at first it was a heart problem - I thought it was a mini stroke - put him in a telemetry unit at first - he kept sleeping the whole time and about 1am he finally stopped breathing and all hands were around his bed - he was then put in CCU and hooked to a lot of machines, etc.

He spent one day in CCU and then put him in ICU - the doctor said that his heart is damaged and that his lungs were really bad - that after his apnea episode 5 years ago that he had 5 more years of damage to the lungs. Guess he will be on the respirator for quite awhile. I do wish that I knew more about it. From what they are saying now, he could not breathe alone now at all.

But I do want to thank you for your quick reply - it meant a lot to me - I will keep you updated if and when he should ever leave the hospital.

I am in Va and only wish that I were closer to central Ohio - ...your letter was the help I needed - I thought that this was serious and that he should be seeing someone - many thanks -

I am sorry that I have not contacted you before this - today has been two weeks since my husband has been put in the ICU unit and still no light at the end of the road - we know he has sleep apnea and that when he entered the hospital his oxygen in the blood was at 63 percent - as I told you before he was incoherent at that time and we thought that he was having a mini stroke - the doctors at the hospital thought that it was his heart and after all was said and done they said yes - it was a very bad case of apnea -

Right now he had been intubated for 12 days and they finally removed that -tried him last night on a C-Pap and he was very agitated by that - they thought that it would be best to intubate him again, but he finally listened to them and decided that he would breathe well for everyone - today he seemed okay, he is still in a daze and says some things that are incoherent - They have a breathing mask on him and he is doing ok with that, but this evening they are going to try the C-Pap or Bi-Pap and see what that does - if he cannot tolerate these, then the ENT doctor will talk to us tomorrow and they want to do a trach [tracheostomy] on him which will help with the breathing -

My question is not, are they doing the right thing and going about it the right way?…

Thanks, B.

Just wanted to keep you informed - my husband is going into the fourth week in the hospital now - he was in ICU for 15 days and then put in a unit called Stepdown - this unit is not as busy as the ICU - not as many doctors walking around and this was not good - one doctor was passing my husband's bed and saw he was blue and said he revived him there and they put him back in ICU where he stayed another couple days - Again he was put in Stepdown and he seemed to do okay, but they kept trying to get him to breathe on his own - sometimes with a soft mask and other times with the oxygen lines. After much talking they tried again with a Bi-Pap and the face mask was so bad - didn't really fit and he had sores all over his face and the back of his ears.

He is now in Telemetry and being monitored all the time - the reps from the C-Pap company came to the hospital yesterday and now he has a C-Pap that fits and that we will be able to rent for a year and then buy it.

He will be transferred next week to a nursing facility for rehab and then finally home - I am afraid that we will be looking at a total of two months by the time he comes home.

Believe me, this apnea is a terrible thing - people do not realize how dangerous it is to the point of being life threatening.

Thank you again for your kind words.

B.

Thank you for your reply - my husband spent another bad night in the Stepdown unit of the hospital - I was with him this morning when the doctor said that they are looking at a trach now - since the C-Pap and Bi-Pap didn't do so well for him - under normal times he is living with 85 percent oxygen in his blood - today it was in the 70's and before it was 60's - I do wish I knew more about this -

I am meeting with the ENT man later on today and will discuss the trach more in detail and find out what they plan if this does not work -They had mentioned the other operation, but he is 70 years old and they don't want to do a major surgery on him in his condition.

You asked about using anything I said on the web site and I think that if this would help anyone - anyone at all - that it would be good - I think that people should be more educated about Apnea and know the dangers of this -

I have almost lost my husband twice now on this hospital stay alone.

Thank you for everything.

B.

MAY 17, 1999. I just received the following e-mail letter. My heart goes out to B. What occurred was a needless death that was preceded by immense suffering. May B's kindness in sharing her painful experiences help protect others from similar tragedies.

I hadn't written in a while - had my husband in the hospital for so very long and they finally released him to rehab where he did not do too well. He came home a week and a half ago and never gained any strength - he died this morning of a massive coronary which was brought on by the apnea - this is a terrible thing and I hope that you have impressed people of the serious nature of this disease.

I felt so very bad that my husband had to endure so much in the hospital - even to the point of having a trach put in only to have nothing help in the end.

Thank you for all your good thoughts.

B.