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 problems.
Sleep apnea is a condition when people have pauses in their breathing while sleeping. Most people have pauses to some degree but people with sleep apnea have much longer pauses, lasting as long as 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 and can lead to problems such as high blood pressure.
There are two main types of sleep apnea – central and obstructive. Central sleep apnea is a problem with the brainstem’s signals to breathe. Obstructive sleep apnea (OSA) occurs much more often than central sleep apnea.
Any type of obstruction of the flow of air in and out of the airway can cause obstructive sleep apnea. The obstruction occurs most commonly in the back of the throat when excess or loose tissue collapses into the airway, usually when the throat muscles relax during sleep. This is why OSA is much more common in overweight individuals who can have a lot of excess tissue in the back of their throats.
People usually seek a medical evaluation for possible OSA 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 that is 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 causing sleepiness at work or school, while driving, or during other restful activities. 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. Home sleep studies are done much more commonly though they don’t collect as much information as when the study is done in a lab. In-lab studies should also be done in patients with particular risk factors. The sleep study data collected during sleep is summarized or “scored.” A physician who has received special training in sleep medicine interprets the test.
A patient must meet specific scoring criteria to be diagnosed with OSA. Treatment for OSA usually involves a device called a CPAP (Continuous Positive Airway Pressure) machine that is connected to either a mask worn on the face or plugs inserted in the nostrils. The CPAP machine blows air into the patient’s airway to inflate it to prevent the tissues from collapsing when sleeping. These machines may be set at a specific air pressure or may adjust themselves automatically to minimize airway blockage.
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
-Dr. John Roberts is a retired member of the Franciscan Physician Network specializing in Family Medicine.