Common, somewhat embarrassing and disruptive, it’s also something almost half of adults do at least occasionally. I’m talking about snoring, of course. The bearlike sounds one emits when snoring are caused by air flowing past relaxed tissues in the throat, causing them to vibrate as you breathe.
It might be the butt of jokes at your house or a source of marital discord, but snoring can signal a major health problem. A number of factors can contribute to snoring, including your mouth anatomy (enlarged tonsils or uvula), being overweight, consuming too much alcohol before bedtime and nasal problems, such as a deviated septum or chronic nasal congestion. It could also be a sign of sleep apnea.
Obstructive Sleep Apnea
The most serious snoring trigger is sleep apnea. “Apnea” in Greek means “without breath.” Several types of sleep apnea exist, but the most common type is obstructive sleep apnea (OSA), which occurs when the tissues in the back of the throat intermittently relax and block your airway during sleep. Sometimes the airway is not totally blocked, but rather, during snoring, the airway becomes so small that the airflow is inadequate. Eventually, the lack of oxygen and an increase in carbon dioxide signal you to wake up, forcing your airway open with a loud snort or gasping sound. This pattern may be repeated many times during the night.
Although habitual snorers are often aware of their nocturnal serenades, most do not realize their breathing may repeatedly stop and start during the night. Sleep apnea’s seemingly innocuous symptoms of snoring and daytime sleepiness resulted in the condition being overlooked or unrecognized for years. Estimates range from 12 million to 20 million sleep apnea sufferers in the United States, with a majority of those undiagnosed.
Are You At Risk?
Some risk factors are hereditary or just the luck of the draw, such as aging (being past 30), male gender, having a family history of sleep apnea, ethnicity (blacks, Hispanics and Pacific Islanders have a greater risk), spine deformities, craniofacial abnormalities and menopause.
However there are a number of risk factors you can influence. For instance, approximately 70 percent of people with sleep apnea are obese. Along the same vein, a large neck circumference more than 17 inches around for men and 16 inches for women is a harbinger for OSA because of the extra tissue around the neck.
Although you wouldn’t think anatomy was something you could change, surgery can sometimes improve sleep apnea. It can correct enlarged tissues or bone deformities of the nose, mouth or throat it can even fix a small, receding jaw.
Drinking alcohol, smoking and taking certain medicines before going to sleep can increase the risk for sleep apnea. Problematic medications include sleeping pills and sedatives. Nicotine in tobacco relaxes the muscles that keep the airways open. Using Viagra (sildenafil) just before sleep also can make sleep apnea worse.
Uncontrolled disorders of the hormone (endocrine) system, such as hypothyroidism, can increase your risk. And oddly enough, poor sleep habits, like going to bed at different times or in different places, is also a risk for OSA.
Why Sleep Apnea Is So Dangerous
Just as an automobile coughs and sputters to a stop when it runs out of gas, so does your body when oxygen levels in your blood decrease during sleep apnea episodes. Carbon dioxide levels go up, and your heart and blood vessels work harder, affecting your heart rate and nervous system. This may lead to other problems, such as high blood pressure, coronary artery disease, stroke or an abnormal heart rhythm. Sleep apnea can also aggravate these diseases and make them harder to treat.
And most significantly, there’s strong evidence that severe obstructive sleep apnea increases your risk of premature death.
Untreated sleep apnea doesn’t just affect long-term health, it also impacts a person’s day-to-day life. Because sleep is interrupted repeatedly, it can make you very tired during the day. If you have sleep apnea, you may:
Be more likely to have a car accident.
Perform poorly at school or work and have difficulty concentrating. You also may have memory problems.
Have personality changes, anxiety and depression.
Lose the desire for sex.
It can also aggravate other chronic conditions, such as chronic pain, asthma and restless legs syndrome.
Diagnosis
Those who have sleep partners are often the lucky ones who actually get diagnosed and treated. Last year Elizabeth Allen from the San Antonio Express-News reported on Rich Schoenfeld, who didn’t realize he had sleep apnea until he married. I’m a light sleeper, said his wife, Carol. What bothered me the most was, of course, the snoring but he would stop breathing. And that was scary. For more than 20 years, she would regularly elbow her husband awake, and then as he drifted back to sleep, she would stay awake to listen to him breathe. At her urging he finally made an appointment with his doctor.
Diagnosis is relatively easy and painless. After discussing it with your primary care doctor, he or she will likely order a polysomnogram. This is an overnight sleep study in a lab that charts your brain waves, heartbeat and breathing as you sleep. It will also record how your arms and legs move. This will reveal if you have OSA and help the doctor categorize the severity of your sleep apnea as mild, moderate or severe. Costs are normally covered by medical insurance.
Treatment
Those with mild OSA may be able to get away with position therapy meaning raising the head of the bed and no more back sleeping or mounds of pillows. In addition, avoiding alcohol, tobacco and medicines such as sedatives before bed is helpful.
Weight loss is recommended for those who are overweight or obese. This helps to decrease the amount of tissue or obstruction in the throat. Significant weight loss is often enough to stop the symptoms.
Another therapy is moving the jaw forward with an oral appliance, much like a sports mouth guard, which causes the airway to stay open.
Continuous positive airway pressure, or CPAP (say “SEE-pap”), is the treatment most often used for moderate to severe OSA. This machine delivers air through a mask worn over the nose or face. The air gently blows into the back of the throat. This keeps the airway open so you keep breathing as you sleep. The amount of air pressure needed is different for each person. A CPAP study will show what level is right for you. This requires another sleep study.
If CPAP doesn’t work, or if your tonsils, adenoids, uvula or other tissues are blocking your airway, your doctor may suggest surgery to open your airway and make breathing easier.
Caveat Emptor
Beware of over-the-counter options touted as cures for sleep apnea. A study conducted at Wilford Hall Medical Center in San Antonio tested a lubricating mouth spray (Snorenz), nasal dilator strips (Breathe Right), and an ergonomically shaped pillow (Snore-No-More), all marketed to stop snoring. Researchers measured participants’ snoring with and without the snoring aids. None of them had significant improvement.
Don’t Sleep On It
If you’re waking up with a headache, feeling tired in the morning or sleepy all the time and your bed partner is annoyed and/or worried, check with your doctor. Don’t ignore it. A good night’s sleep and a clear head await you.
