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Snoring and Sleep Apnea

Is it snoring or something else? Snoring is annoying and may disturb your sleep, the sleep of whoever shares your bed and even people in other areas of your home. Snoring can make relationships stressful, but it can also be the first sign of sleep apnea, a much more serious health problem. Research shows that approximately 30-50% of habitual snorers have some degree of sleep apnea.

Snoring is the noise made by vibration of the tissues in the back of the throat as we breath in during sleep. Sleep apnea is a condition in which an individual will have episodes where they stop breathing for at least 10 seconds during sleep.The term apena comes from the greek and means "without breath". In order to resume breathing, the person must briefly awaken, usually with choking and gasping. In a person with sleep apnea, this cycle will occur repeatedly throughout the night. 

Signs Of Sleep Apnea

  • Gasping, choking or snorting during sleep
  • Feeling sleepy or tired, in spite of a full night’s sleep
  • Waking up tired or with a headache
  • Falling asleep in inappropriate situations (movies, church, sitting quietly) or without intending to sleep
  • Problems with memory and concentration
  • Being ill-tempered or irritable
  • Getting up frequently during the night to urinate

Sleep apnea has been associated with an increased risk for serious medical conditions such as stroke, diabetes, cardiovascular disease – including high blood pressure, heart arrhythmias and heart attack. Even erectile dysfunction has been associated with sleep apnea. I addition, many motor vehicle accidents are attributed to daytime sleepiness as a result of sleep apnea.

Sleep apnea is very common and is estimated to affect as many as 18 million Americans or about 1 in every 15 individuals. Of the three types of sleep apnea (obstructive, central and mixed), obstructive is the most common. In obstructive apnea, the passageway between the nose and the throat closes due to several possible causes. In central sleep apnea, the airway is not blocked, but the brain fails to tell the body to breathe. Mixed sleep apnea is a combination of obstructive and central sleep apnea symptoms. In 2006 researchers from the Mayo Clinic conducted a study of 223 sleep apnea patients and found that 15% of those who were believed to have only obstructive sleep apnea in fact had mixed sleep apnea.

Diagnosis

The diagnosis of sleep related breathing disorders will be made by a qualified physician.

At the Clinical Center for Facial Pain and Sleep Medicine, Dr. Bender will inquire about your sleep problems, provide questionnaires and perform a comprehensive examination. Oftentimes, an overnight sleep screening will be recommended. This screening helps determine if you should be reffered for evaluation by a qualified physician. 

History – Dr. Bender may inquire about how long you have snored, your sleep habits, lifestyle and work issues, medical conditions, medications used, daytime sleepiness, and the impact snoring has on you and those who live with you.

Physical Exam – As a part of your comprehensive examination at the Clinical Center for Facial Pain and Sleep Medicine, Dr. Bender will look in your mouth, nose and throat, to look for signs indicative of sleep related breathing issues. The examination may show a decreased space at the back of your mouth and in your nose limiting healthy airflow.

Sleep Study – This test is performed in a sleep center or in some cases your own home and will provide the information needed  to make the most accurate diagnosis of your condition. The tets typically measures your breathing, heart rate, oxygen saturation, muscle activity and other functions. 

Anatomy Of Breathing

Air travels through nasal passages and the throat. Normally these passages are open enough to allow air to flow freely, and breathing is normal. The passages can become constricted, causing snoring; if they become sufficiently narrowed or blocked, apnea can result. The ideal mode of breathing is through the nose. Under normal conditions, air passes through the nose and throat and into the lungs. This mode of breathing warms, humidifies and filters the air, thus improving the available oxygen.

Nasal Structures – The inside of the nose is divided by what is known as a septum. Along the inside walls of the nose are ridges called turbinates. A deviated septum can make breathing through the nose more difficult. The turbinates can become swollen and enlarged, often due to chronic allegies, decreasing the ability of air to pass through the nose. 

Often people who have chronic difficulty breathing through their nose will become mouth breathers. Any obstruction to normal nasal breathing may need to be evaluated and possibly corrected in order to help treat a snoring or sleep apnea problem.

Throat Structures – At the back of the mouth is the soft palate, uvula, tonsils and the rear portion of the tongue. Muscles hold these structures in position. While sleeping, these muscles relax, but usually hold the structures firm enough to keep the airway open.

If the airway is already narrow or if these structures become enlarged, the realaxtion of these muscles during sleep can further constrict the airway causing it to temporarily close, leading to sleep apnea.

What You Can Do To Improve Sleep

Changing certain habits may improve your sleep. While these changes may take some time and effort on your part, the improvement in sleep will be well worth it.

Sleep On Your Side – If you sleep on your back, gravity may pull the tissues of your throat down, blocking your airway. Sleeping on your side may help keep your airway open.

Lose Weight – People who are overweight often have bulky and excess tissues in their throat which can make snoring and apnea worse. Your doctor can help you develop a plan to lose weight and keep it off.

Avoid Alcohol And Certain Medications – Alcohol and some medications like sleeping pills, some antihistamines, and sedatives can relax the muscles of your throat, which may worsen snoring and apnea. Alcohol and certain medications can also disrupt normal sleep structure causing you to feel more tired the next day. Avoid alcohol three to four hours before sleep and talk to your doctor about medications you take that can impact your sleep.

Clear Your Nose – A clogged nose won’t let air in as easily. Allergies and sinus problems can also contribute to difficulty breathing through your nose. Nasal strips may help make breathing easier. There are also nasal rinses and sprays that can make nasal breathing easier. Your doctor will recommend these if they are appropriate.

Avoid Eating Near Bedtime – Allow three to four hours between eating and bedtime.

Put Away Electronic Devices!- Due to the light that they emit, the use of electronic devices prior to bedtime can delay the production of melatonin resulting in difficulty falling alseep. Melatonin is a hormone produced in the brain that begins to be released around dusk and causes you to begin to get drowsy.

Management

Many treatment options are available for snoring and sleep apnea. The recommended therapy for sleep apnea depends on its severity and patient preference. 

PAP –  Positive Air Pressure (CPAP) consists of a small device that pumps air into a mask that is held over your nose by a strap. The air pressure prevents the airway from collapsing, allowing you to breathe more easily. PAP is sometimes combined with other treatments. For most people with sleep apnea, PAP will be the first type of treatment recommended.

Types of PAP – Basic CPAP (continuous positive pressure) keeps constant air pressure in the airway all night. A bi-level CPAP senses when you breathe in and out and automatically adjusts the air pressure accordingly. An auto adjusting CPAP machine automatically responds to changes in body position, how deeply you are breathing, and if you are snoring.  These devices can also humidify the air so the tissues do not dry out. Your doctor will assist you in deciding which type of device is best for you.

Compliance with CPAP – It takes most people some time to get used to the CPAP. Many of the problems can be overcome by changing the type of machine you use, modifying the mask, or other aspects of this treatment. However, some people, no matter what they try, cannot tolerate using CPAP.

Oral Appliance Therapy – Provides an alternative to CPAP. Custom-fabricated oral appliances hold the lower jaw and tongue slightly forward to create more space in the back of the mouth and throat, increasing the airway space and preventing the tongue and lower jaw from collapsing back causing airway obstruction. These devices are generally well tolerated and work well but, like CPAP, are not for everyone. At the Clinical Center for Facial Pain and Sleep Medicine, we can help you determine if you are a good candidate for an oral appliance. Like CPAP, oral appliances require getting used to and will need to be adjusted to determine the optimum position for each patient. These appliances require maintenance and follow-up visits to make sure they continue to fit correctly and help you breathe better.

Surgery – These are procedures designed to widen and/or stabilize the upper airway to reduce the severity and impactof sleep disordered breathing.