SLEEP AND SNORING

Snoring is caused by a fluttering sound in the back of the throat and nose. Vibrating tissues can be from the soft palate, throat, uvula, tonsils, adenoids, or from obstruction of air going through the nose.  Bedmates of snorers lose an average of one hour of sleep per night. Many snoring couples sleep apart which can result in strained relationships. Although estimates vary in the literature, approximately 75 million Americans snore.

Yet snoring can be an even more important warning sign of a very dangerous medical condition: Obstructive Sleep Apnea. Not everyone who snores has sleep apnea, but almost 100 percent of those with sleep apnea snore.

The Greek word “apnea” means “without breath”. So sleep apnea means not breathing while you sleep. There are many causes of sleep apnea. The most common type of sleep apnea is obstructive. This means there is some type of obstruction, or blockage, interfering with your ability to breathe during sleep. All people with untreated sleep apnea stop breathing during sleep, sometimes up to a hundred times per night. These low or absent breathing events are often associated with decreases in the oxygen in the blood. With each apnea event, the brain wakes you up in order to make sure you resume breathing. But since you keep waking up to make sure you are breathing, your sleep is extremely fragmented and of poor quality.  

Sleep apnea is very common and affects more than 12 million Americans. Sleep apnea affects both men and women and can be present at any age, even in children.

There are many causes of sleep-disordered breathing and apnea. Obstructive sleep apnea is caused by a blockage in the airway, usually when the soft tissue of the rear of the throat collapses and closes during sleep. As we age, the airway tissue loses tone and elasticity. Lifestyle effects such as excess weight and the use of alcohol can lead to apnea. Equally important is the contribution of the person’s anatomy, ie, how is your body put together. Are your tonsils big? Do you have a large tongue?  Do you have a twisted septum, which is the bone and cartilage which divides the middle of your nose? Some of these anatomical (body shape) differences can be inherited. Yes, you can thank Grandma and Grandpa for some of this. But some of what causes sleep apnea comes from our lifestyle choices. Yes, our weight, which may put extra layers of fat in our necks, or tongue, or back of our throat.

The diagnosis of sleep apnea comes from a combination of the history, physical exam, and tests such as a polysomnogram, or sleep study. The history might include questions such as:

• Do you snore?
• Are you tired during the daytime?
• Do you have high blood pressure?
• How long does it take for you to fall asleep?
• Have you gained weight recently?

The physical exam includes a thorough exam of the mouth, throat, nose, and airway. We check the look of the palate, tonsils, whether they are present, and how big, the relationship of the tongue to the palate, whether the nose is open on both sides, where your chin is relative to the back of your jaw. The doctor may perform a scope or a nasal or flexible endoscopy. This is a camera inserted into your nose to visualize your anatomy, and this helps to determine what the likely cause is of your sleep apnea, as well as help to determine the best treatment customized for you. 

The next step after the physical exam is to obtain a sleep study. You may be referred for an “in-lab” study, where you spend the night in a sleep laboratory. You will closely be monitored for sleep-disordered breathing. Alternatively, a home sleep study might be recommended. This is where you take the test home with you and sleep in your own bed. It is not as accurate as an “in-lab” study but may give us enough information to be able to make some treatment plans.  After the study, we will interpret the study and find out pieces of valuable information such as; do you snore? If so, how much and what percentage of the time, are you stopping breathing? If so, how many times per hour, and for how long, are you having good quality sleep including deep sleep? Are you kicking your legs, and thus waking up frequently, how many times do you wake up during the night?  There may be other causes for daytime sleepiness such as narcolepsy, which a sleep study along with another test can help to diagnose.

If you do have sleep apnea, we will categorize it as mild, moderate, or severe, and recommend treatment.

There are significant health consequences to untreated apnea. These low or absent breathing events are often associated with decreases in the oxygen in the blood.  With each apnea event, the brain wakes you up in order to make sure you resume breathing. But since you keep waking up to make sure you are breathing, your sleep is extremely fragmented and of poor quality. But that’s not all. Sleep apnea can lead to heart disease, high blood pressure, reflux, and strokes. Furthermore, sleep apnea decreases your metabolism making it difficult to lose weight, and actually makes you gain weight making the chance of apnea worse. It can lead to diabetes with insulin resistance. It can even cause dementia, depression, and anxiety. And let’s not forget about the worse part of not getting a good quality sleep….you are tired! Really tired! And this can lead to decreased productivity at work or school and even car accidents.