Snoring & Sleep Apnea
Almost everyone is likely to snore at one time or another. It has been found in all age groups. Estimates of snoring vary widely based on how it is defined. The rate of snoring in children is reported to be 10% to 12%. Habitual snoring has been found in about 24% of adult women and 40% of adult men. Both men and women are more likely to snore as they age. Men, however, become less likely to snore after the age of 70. Snoring is more common in people who are overweight. There is a greater amount of fat in the back of the throat that vibrates as they sleep. Nasal obstruction raises the risk of snoring. It has also been shown to increase during pregnancy. Snoring appears to run in families.
Snoring is a warning noise produced by the force of air through a narrowed upper airway, caused by the collapse of soft tissue in the back of the throat. It is an indication that there is a problem with normal breathing. That’s why it’s very important to be properly evaluated by a sleep specialist for underlying obstructive sleep apnea, since snoring acts as a warning sign. Some treatments may resolve the snoring alone, but they fail to treat the sleep apnea which is associated with significant health risks.
People who snore have a higher rate of heart disease, which is a leading cause of death in the U.S. Snoring can also be a sign of obstructive sleep apnea (OSA). OSA raises your risk of having heart problems.
Snoring can cause headaches, difficulty in concentration, fatigue and reduced work performance. The effects of snoring can also annoy one’s bed partner, whose sleep quality may also be adversely affected.
Sleep Apnea in Adults
There are 2 primary types of sleep apnea: obstructive and central. Apnea is defined as not breathing for 10 seconds or longer. Central sleep apnea is a breathing disorder that causes your body to decrease or stop the effort of breathing during sleep. This occurs in an off-and-on cycle. It is a result of a problem in the brain or heart. It’s different from obstructive sleep apnea (OSA) because the problem is not caused by a blockage of the airway. There are a few different types of central sleep apnea, but they mainly occur in the following groups: middle-aged or elderly individuals, those with chronic congestive heart failure or stroke, people affected by heart or kidney problems, people in high altitudes (higher than 15,000 feet or about 5,000 meters), and those taking long-acting opioid drugs for longer than two months.
Obstructive sleep apnea, or OSA, is a sleep-related breathing disorder that causes your body to stop breathing during sleep. This is a very common sleep disorder. OSA occurs when the tissue in the back of the throat collapses and blocks the airway during sleep. This obstruction keeps air from getting in to the lungs. It happens because the muscles in the throat relax as you sleep. Gravity then causes the tongue to fall back and block the airway. Blockage of the airway can happen a few times a night or several hundred times per night.
- Loud snoring
- Snoring interrupted by pauses in breathing and then gasping
- Falling asleep at inappropriate times
- Trouble with concentration or memory, irritability, depression, loss of interest in sex, or impotence
- Headaches, dry mouth, sore throat or nausea upon awakening
- Frequent nighttime urination or even bed-wetting
- snore every night?
- wake up suddenly during the night perspiring, choking or gasping for air?
- wake up in the morning with headaches or a sore throat?
- fight falling asleep during the day, at work or while driving?
- feel irritable, have memory loss or a lack of concentration each day?
- suffer with obesity, gastric reflux, or high blood pressure?
Almost all people with OSA snore loudly, and about half of the people who snore loudly have OSA. Snoring is a sign that your airway is being partially blocked. While you may not think you snore, ask the person who sleeps next to you. He or she can tell how often you snore and whether or not you stop breathing.
Many people with OSA are sleepy during the day. They find that they are still tired even after a nap. When you stop breathing, your body wakes up. It happens so quickly, you aren’t even aware of it. This event disrupts your sleep process. You can stop breathing hundreds of times in one night. This repetitive disruption of sleep will make you feel very tired the next day. As a matter of fact, a person with OSA has 3 times the likelihood of being involved in a car accident.
Treatment of sleep apnea can reduce and possibly reverse the risks for these adverse outcomes. Early recognition and treatment of sleep apnea has been shown to reverse the symptoms and to prevent the occurrence or worsening of these consequences. It is important to talk to your doctor about problems with your sleep, as sleep disorders are readily treatable.
There are a few different alternatives for the treatment of OSA. For mild sleep apnea, position therapy may work. Sleeping on your side instead of on your back will reduce symptoms. Also, raising the head of the bed may reduce symptoms. There’s an unusual method that’s been described to help someone avoid sleeping on their back. It involves sewing a pouch or pocket into the back of a t-shirt. Then you place a tennis ball in the pouch. So when you roll on to your back during the night, the uncomfortable tennis ball will remind you (like it or not) to sleep on your side. That’s a far-fetched method to sleeping on your side. Many people with undiagnosed OSA may unwittingly be sleeping on their side, as their body attempts to compensate for their sleep-related breathing disorder.
Another recommended treatment for OSA is weight loss. Weight loss is very important as this decreases the amount of obstruction in the throat. Often a significant amount of weight loss is enough to reduce the symptoms. However, even if you are working to lose weight, you should consult with your doctor to monitor for any persistent OSA. Even mild persistent OSA can result in many of the serious consequences mentioned above.
Continuous positive airway pressure (CPAP) is the treatment most often used to treat OSA. It is a device which blows air into the back of the throat to keep the airway open while you sleep. The air is delivered through a small hose attached to a mask worn over the nose or face. The amount of air pressure needed is different for each person. An overnight CPAP study will determine what level is right for you. Many people may initially dejected and skeptical about being able to sleep with such a device. However, we work very closely with our patients during this process at Dallas Sleep. After a careful adjustment period of 2-4 weeks, most patients are comfortable sleeping with CPAP. In fact, many patients notice the difference in how much better they feel after just a few nights of treatment. The feelings of fatigue, irritability, headaches and dry mouth can be reversed very quickly.
Surgery is another option that may help an OSA patient. The size of the upper airway is increased to prevent collapse of the airway and to make breathing easier during sleep. Increasing the size of the upper airway can be done in two different ways: 1) by removal of redundant soft tissues in the back of the throat or 2) by expansion of the jaw structures that restrict the space in the throat. Procedures are also available to reduce the laxity of the upper airway and to reduce nasal obstruction, if present. Because the airway pattern and the severity of obstruction vary greatly between individuals, the success rate of a given surgical procedure also varies greatly. In general, as the severity of OSA increases, so does the invasiveness of the required procedures to achieve successful surgical outcomes.
However, to improve the odds of a successful outcome, the surgery should be performed by an Ear, Nose and Throat surgeon who is skilled in doing sleep apnea surgeries. This is an important point, because not all ENT specialists are trained in sleep apnea surgery. In the hands of a skilled surgeon, the overall success rates for the various procedures can range between 50-80%, for a complete cure. Since CPAP is essentially 100% effective if used properly, most surgeons agree that a trial of CPAP is the first step in treatment.
Finally, another viable treatment option is an oral appliance. It is worn in the mouth as you sleep. This device is similar to a sports mouth guard, and it’s used to move the lower jaw forward. By keeping the lower jaw extended, it helps to prevent the tongue and soft tissues of the throat from obstructing the airway. According to the most recent Practice Parameters developed by the American Academy of Sleep Medicine, these oral appliances are indicated only for the treatment of mild to moderate OSA. The device is custom-designed by a dentist or dental lab familiar with this technology. Moreover, it’s important to know that once you are fitted with such a device, you should have an overnight sleep study to check its efficacy.