Carrie Fisher didn’t die from just one cause, but sleep apnea was a major contributor, the coroner’s office stated this week. Other contributing factors included atherosclerosis, a build-up of plaque — cholesterol, fatty tissues, calcium and other substances — in the arteries, and drug use.
The coroner didn’t specify whether it was illegal drugs or current prescriptions for her medical issues, but no doubt her past drug use didn’t help. Fisher also smoked, which greatly increases the risk that atherosclerosis will lead to coronary artery disease.
Of course, none of this surprised her family. Her brother, Todd Fisher, said in a statement, “If you want to know what killed her, it’s all of it.”
Most Americans probably already knew that as well.
The dangers of illegal drugs, smoking, poor diet, addiction and heart disease are already well-known to most people, and Fisher was unabashedly vocal about her struggles with addiction and bipolar disorder, which contribute to poorer health too.
But what’s up with the sleep apnea?
It’s a remarkably common disorder that more than triples a person’s risk of death—especially if they don’t know they have it.
It’s not clear whether Fisher herself knew she had it.
More than 25 million Americans have sleep apnea, and those are just the ones who have been diagnosed.
One study estimated that one in four adults between 30 and 70 years old has mild to severe sleep apnea. In fact, it’s the leading cause of daytime sleepiness.
A person with obstructive sleep apnea frequently stops breathing for short periods while sleeping — an “apnea” is a pause of at least 10 seconds while breathing — due to periodically blocked airways.
They subsequently experience reduced oxygen levels in the blood, disrupted sleep, fatigue and daytime sleepiness.
Moodiness, depression, obesity and diabetes are also more common among sleep apnea sufferers, as is high blood pressure and heart disease. In fact, even substance abuse is associated with sleeping disorders: someone may take stimulants to stay awake because of daytime sleepiness, and then they need depressants to fall asleep… and the cycle begins.
As one dentist who specializes in sleep medicine told the Washington Post, it’s not the sleep apnea itself but its downstream effects that kill people. “Sleep apnea is a time bomb,” John Bouzis told the paper.
Sleep apnea is tricky to diagnose because the symptoms are so common: in addition to sleepiness and fatigue, snoring is a major symptom, though not everyone who snores has obstructive sleep apnea. And unless you sleep in a room with someone else, it’s virtually impossible to know if you’re snoring or experiencing other symptoms in your sleep.
Doctors can screen for the condition — the most common and accurate screening tool is the 8-question STOP-BANGtool— but the only way to be sure about a diagnosis is to do an overnight sleep study in which a person spends the night in a lab hooked up to devices that monitor their sleep and breathing. That’s neither convenient nor cheap.
But the inconvenience is worth finding out. Severe, untreated sleep apnea nearly quadruples the risk of death compared to those without sleep apnea, and the risk of heart disease is five times greater. The first-line treatment for obstructive sleep apnea is continuous positive airway pressure, or CPAP, using a device that forces air into a person’s airways to keep them open and functioning.
Despite the fact that CPAP therapy reduces the riskof heart disease and diabetes complications, not nearly enough people with sleep apnea use the treatment. In one study, a third of people stopped using CPAP, and one in five stopped within the first six months.
There are alternatives for those who don’t or can’t use CPAP, such as oral appliances that keep the airway open, surgery and various devices, but CPAP remains the gold standard and most effective treatment.
Many reasons account for low adherence to the therapy. Personality plays a role: type D folks, those more likely to feel irritable, gloomy and less socially interactive, are less likely to stick with CPAP. It’s also admittedly not the most comfortable therapy: it requires wearing a face mask during sleep that forces pressurized air into the person’s airways, ensuring that the airways are always open and the person doesn’t experience apneas. Most CPAP machines require electricity, which makes travel and camping more difficult and inconvenient.
Although men are diagnosed with sleep apnea at a much higher rate than women, it’s not clear that the condition actually occurs that much more in women.
More likely, many women are going undiagnosed, especially after menopause when the risk of obstructive sleep apnea increases.
Obstructive sleep apnea during pregnancy can increase the likelihood of pre-eclampsia, hypertension, cardiovascular disease, cesarean delivery or newborn death.
Fisher’s willingness to share her struggles with mental illness and her advocacy for destigmatizing it are as legendary as her role as Princess — later General — Leia.
No doubt, then, she would likely want others to seek help for another condition that helped take her life.
And just as the stigma of mental illness can prevent people from seeking help, the stigma of snoring is one factor preventing women from being diagnosed and treated for sleep apnea. And as with mental illness, it’s a stigma that can kill if it stops people from getting a diagnosis and treatment.