Stop The Snoring!
Snoring can certainly be annoying, but it doesn’t always indicate a serious medical problem. However, sometimes snoring can be due to sleep apnea, a condition that can lead to significant medical issues.
Sleep apnea is a condition where people have pauses in their breathing while sleeping. Most people have pauses to some degree, but people with sleep apnea have much longer pauses, sometimes lasting up to 30 seconds. These long pauses cause the level of oxygen in the blood to drop and carbon dioxide to rise. These changes can be very hard on the body, especially the heart and lungs. It can also lead to high blood pressure.
There are two main types of sleep apnea – central and obstructive. Central sleep apnea is a problem with how the brainstem sends signals to the breathing muscles. This is a less common cause of sleep apnea in adults; obstructive sleep apnea (OSA) is seen much more often.
Obstructive sleep apnea is caused by any type of obstruction to the flow of air in and out of the lungs. This usually occurs in the back of the throat when excess or loose tissue collapses into the throat when the throat muscles relax during sleep. This is why OSA is much more common in overweight individuals who can have a lot of floppy tissue in the back of their throats.
When I see people in my office who feel they may have OSA, it is usually at the request of a spouse or significant other who is either being awakened by snoring or who has actually seen the patient stop breathing during sleep. They often describe a cycle of snoring respirations, followed by long pauses, then gasping for air. The snoring results from vibrations of the tissue in the back of the throat, quite similar to the vibrations of strings on an instrument.
There are other signs and symptoms we ask about when evaluating people for OSA. Sleep apnea sufferers are unable to fall into a deep sleep – the apneas can wake them tens or even hundreds of times per night. This can result in excessive daytime sleepiness and an increase in falling asleep at work or school, while driving, etc. Patients frequently complain of fatigue, irritability, dry mouth, a reduced ability to concentrate and headaches. They may have hypertension or other heart or lung diseases. They often consume caffeine or other stimulants to try to stay awake during the day.
The diagnosis of sleep apnea is suggested by the history, but in order to confirm the diagnosis a sleep study or polysomnogram must be performed. These studies have historically been done in a sleep lab where patients are connected to monitoring equipment that records respirations, brain wave activity, movements via a video camera as well as sensors that measure gas exchange in and out of the lungs. Sleep studies done in the home are becoming more common, though they don’t collect as much information as when the study is done in a lab. They also should not be done in patients with particular risk factors. The sleep study data is collected during sleep then summarized or “scored.” A physician who has received special training in sleep medicine interprets the test.
There are very specific scoring criteria a patient must meet to be diagnosed with OSA. Once diagnosed, treatment usually involves a device called a CPAP (Continuous Positive Airway Pressure) machine that is connected to a mask worn on the face or plugs inserted in the nostrils. The machine blows air into the patient’s airway to inflate it and prevent the tissues from collapsing when sleeping. These machines may be set at a specific air pressure, or may adjust themselves automatically to maximize air flow.
If you feel you may have sleep apnea or know someone who does, you should see a physician to discuss testing. OSA is a very serious condition that can lead to or worsen cardiovascular, lung and neurologic problems. You can do a quick screen for sleep apnea here: www.stopbang.ca/osa/screening.php. For more information on sleep apnea, see bit.ly/2z6OAQx.