Snoring and Sleep Apnea
Are you one of 7?
Approximately one in every seven adults experience sleep-disordered breathing (SDB).1
Sleep-disordered breathing is characterized by numerous, brief (10 second or so) interruptions of breathing during sleep. These interruptions, which usually occur when relaxation of the upper airway muscles decreases airflow, lower the level of oxygen in the blood and, as a result, affected individuals are frequently aroused from deep sleep as they struggle to breathe. Symptoms of sleep-disordered breathing include loud snoring and daytime sleepiness. The most common form is SDB is Obstructive Sleep Apnea (OSA).
OSA can occur in men, women and children of all ages and sizes. Most people who have OSA do not realize they suffer from the condition. Often, it is someone else who witnesses the first signs of OSA.
The signs and symptoms of obstructive and central sleep apneas overlap, sometimes making the type of sleep apnea more difficult to determine. The most common signs and symptoms of obstructive and central sleep apneas include:
- Excessive daytime sleepiness (hypersomnia)
- Loud snoring, which is usually more prominent in obstructive sleep apnea
- Observed episodes of breathing cessation during sleep
- Abrupt awakenings accompanied by shortness of breath, which more likely indicates central sleep apnea
- Awakening with a dry mouth or sore throat
- Difficulty staying asleep (insomnia)
- Snoring (people with OSA usually snore but not always)
- Impaired concentration
- Impaired memory
- Morning headaches
- Sexual dysfunction
When to See a Doctor
Consult a medical professional if you experience, or if your partner observes the following:
- Snoring loud enough to disturb the sleep of others or yourself
- Shortness of breath that awakens you from sleep
- Intermittent pauses in your breathing during sleep
- Excessive daytime drowsiness, which may cause you to fall asleep while you're working, watching television or even driving
Many people don't think of snoring as a sign of something potentially serious, and not everyone who has sleep apnea snores. But be sure to talk to your doctor if you experience loud snoring, especially snoring that's punctuated by periods of silence.
Ask your doctor about any sleep problem that leaves you chronically fatigued, sleepy andirritable. Excessive daytime drowsiness (hypersomnia) may be due to other disorders,such as narcolepsy.
It's Not Just About You
People who sleep next to a snorer have more pain, higher levels of fatigue and sleepiness and may even be at higher risk for hearing loss, according to two recent studies. Complaints of snoring and apnea have risen sharply in recent years along with the general increase in obesity, a risk factor for sleep problems. Research shows2:
People who sleep next to snorers may wake up as often during the night as people with documented sleep disorders.
One Mayo Clinic study found that spouses of snorers woke at least partially an average of 21 times an hour, nearly as often as the 27 times the snorers were awakened by their documented sleep problem.
Spouses of snorers and people with sleep apnea complain of excessive daytime sleepiness and fatigue, which can affect relationships at both work and home.
What are the Risk Factors?
Sleep apnea may occur if you're young or old, male or female. Even children can have sleep apnea. But certain factors put you at increased risk:
Excess weight. Fat deposits around your upper airway may obstruct your breathing. However, not everyone who has sleep apnea is overweight. Thin people develop the disorder, too.
Snoring (Snoring can cause the soft palate to lengthen, which in turn can obstruct the airway)
Neck circumference. The size of your neck may indicate whether or not you have an increased risk of sleep apnea. That's because a thick neck may narrow the airway and may be an indication of excess weight. A neck circumference greater than 17.5 inches (44 centimeters) is associated with an increased risk of obstructive sleep apnea.
High blood pressure (hypertension). Sleep apnea is not uncommon in people with hypertension.
A narrowed airway. You may inherit a naturally narrow throat. Or, your tonsils or adenoids may become enlarged, which can block your airway.
Being male. Men are twice as likely to have sleep apnea as women are. However, women increase their risk if they're overweight, and the risk also appears to rise after menopause.
Family history. If you have family members with sleep apnea, you may be at increased risk.
Other disorders and syndromes. Hypothyroidism, acromegaly, amyloidosis, vocal cord paralysis, post-polio syndrome, neuromuscular disorders, Marfan's syndrome, and Down Syndrome.
Other physical conditions. Conditions such as immune system abnormalities, severe heartburn or acid reflux and high blood pressure. It isn't clear whether the conditions are the cause or the result of sleep apnea.
Use of alcohol, sedatives or tranquilizers. These substances relax the muscles in your throat.
Smoking. Smokers are three times as likely to have obstructive sleep apnea as are people who've never smoked. Smoking may increase the amount of inflammation and fluid retention in the upper airway. This risk likely drops after you quit smoking.
Heart disorders. People with atrial fibrillation or congestive heart failure are more at risk of central sleep apnea.
Stroke or brain tumor. These conditions can impair the brain's ability to regulate breathing.
What happens if I do not treat my sleep apnea? (Viewer clicks here)
Sleep apnea is considered a serious medical condition. Left untreated, complications may include:
Cardiovascular problems. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. If you have obstructive sleep apnea, your risk of high blood pressure (hypertension) can be up to two to three times greater than if you don't. The more severe your sleep apnea, the greater the risk of high blood pressure.
Stroke. Obstructive sleep apnea also increases the risk of stroke, regardless of whether you have high blood pressure. People with sleep apnea are three times more likely to suffer a stroke or die, compared to people in a similar state of health but without sleep apnea.3
Daytime fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible. People with sleep apnea often experience severe daytime drowsiness, fatigue and irritability. You may have difficulty concentrating and find yourself falling asleep at work, while watching TV or even when driving. You may also feel irritable, moody or depressed. Children and adolescents with sleep apnea may do poorly in school or have behavior problems.
Traffic accidents. Studies have shown that patients with OSA perform poorly on driving simulation tests and have an accident rate 2-7 times as high as people without OSA.4
Sleep-deprived partners. Loud snoring can keep those around you from getting good rest and eventually disrupt your relationships. It's not uncommon for a partner to go to another room, or even on another floor of the house, to be able to sleep. Many bed partners of people who snore are sleep deprived as well.
Memory problems, depression and other complications. People with sleep apnea may also complain of memory problems, morning headaches, mood swings or feelings of depression, a need to urinate frequently at night (nocturia), and impotence. Gastro esophageal reflux disease (GERD) may be more prevalent in people with sleep apnea. Children with untreated sleep apnea may be hyperactive and may be diagnosed with attention-deficit/hyperactivity disorder (ADHD).
Complications with medications and surgery. Obstructive sleep apnea is also a concern with certain medications and general anesthesia. People with sleep apnea may be more likely to experience complications following major surgery because they're prone to breathing problems, especially when sedated and lying on their backs. Before you have surgery, tell your doctor that you have sleep apnea. Undiagnosed sleep apnea is especially risky in this situation.
Type II Diabetes. Recent reports have indicated that the majority of patients with type 2 diabetes also have obstructive sleep apnea (OSA). Data suggests that OSA is also independently associated with alterations in glucose metabolism and places patients at an increased risk of the development of type 2 diabetes. 5
How is OSA treated? (Viewer clicks here)
For milder cases of sleep apnea, your doctor may recommend lifestyle changes such as losing weight or quitting smoking. If these measures don't improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments are available. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.
Treatments for obstructive sleep apnea may include:
Continuous positive airway pressure (CPAP). If you have moderate to severe sleep apnea, you may benefit from a machine that delivers air pressure through a mask placed over your nose while you sleep. With CPAP (SEE-pap), the air pressure is somewhat greater than that of the surrounding air, and is just enough to keep your upper airway passages open, preventing apnea and snoring.
Although CPAP is a preferred method of treating sleep apnea, some people find it cumbersome or uncomfortable. In fact, many sleep apnea patients are experiencing even greater success with the use of an oral appliance such as the OASYS.
Oral appliances. Another option is wearing an oral appliance designed to keep your throat open. CPAP is more effective than oral appliances, but oral appliances may be easier for you to use. The OASYS is the first dental device to address both vulnerable regions of the respiratory tract. By repositioning the mandible it holds the lower jaw forward to keep open the pharyngeal area in back of the tongue. Acting as a nasal dilator, it decreases airway resistance so it improves ease of airflow through the nasal passage.
Benefits of dental devices such as the OASYS seem to offer the following benefits:
- Significant reduction in apneas for those with mild-to-moderate apnea, particularly if patients sleep either on their backs or stomachs. They do not work as well if patients lie on their side. The devices may also improve airflow for some patients with severe apnea.
- Improvement in sleep in many patients.
- Improvement and reduction in the frequency of snoring and loudness of snoring in most (but not all) patients.
- Higher compliance rates than with CPAP.
Dental devices have also shown better long-term control of sleep apnea when compared to uvulopalatopharyngoplasty (UPPP), the standard surgical treatment. There are also few complications with a dental device.
The goal of surgery for sleep apnea is to remove excess tissue from your nose or throat that may be vibrating and causing you to snore, or that may be blocking your upper air passages and causing sleep apnea. Surgical options may include the following: uvulopalatopharyngoplasty, maxillomandibular advancement, nasal surgery and tracheostomy.
1 Punjabi Naresh M., Caffo, Brian. and Et al. Sleep-Disordered Breathing and Mortality: A Prospective Cohort Study.
2 Tara Parker-Pope, "Dangers of Second-Hand Snoring: When Bedtime Is a Health Hazard," Wall Street Journal, November 18, 2003
3 American Physiological Society (2009, January 12). What Is The Connection Between Sleep Apnea, Stroke And Death?
4 Santos-Teran J., Jimenez-Gomez, A. and et al. Association between Sleep Apnea and the Risk of Traffic Accidents. The Cooperative Group Burgos-Santander
5 Tasali E, Mokhlesi B, and Van Cauter E.. Type II Diabetes and Sleep Apnea. University of Chicago, Department of Medicine.