Snoring and Sleep Apnea

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What is sleep apnea?

Usually associated with snoring, sleep apnea means the cessation of breathing during sleep. This breath-holding initially lasts for 10 seconds and progresses to 20 to 30 seconds, and each episode is immediately followed by gasping for air. This cycle could repeat itself several times (20 to 100 times per hour) the whole night long. The snorer is totally oblivious of all this and only the roommate is aware of this bothersome snoring and scary sleep apnea.

How prevalent is sleep apnea?

The incidence is about 2% among middle-aged women and 4% among men of that age group, which is similar to the incidence of diabetes and asthma. Sleep apnea is a primary risk factor for hypertension (high blood pressure).

What are the types of sleep apnea?

There are two types: Central Sleep Apnea (CSA) and Obstructive Sleep Apnea (OSA). CSA is much less common, less than 10% of cases comprises this group, and is due to the brain's failure to send a signal for the person to breathe. This can happen among individuals with cardiac or neurological diseases. In OSA, part of the back of the throat collapses and blocks the airway during sleep, preventing airflow to the lungs. This causes decreased oxygenation and a low blood oxygen level, which alerts the brain to transmit a "wake up and breathe" message to the sleeping person.

What effects does sleep apnea have?

The person wakes up with a dry mouth and throat, perhaps with a headache, and a lousy feeling akin to a hungover. There may also be fatigue and sleepiness throughout the day, together with some memory deficiency, poor attention and concentration, and bad mood --- all signs of lack of sleep, due to sleep apnea. The psychological stress of all this impacts negatively on the individual. The recurrent transient hypoxemia (low blood oxygen level) and daily impairment of sleep are added risk factors for the development of hypertension and coronary heart disease.

What causes snoring?

In some people, especially after middle age, the muscles of the upper airways in the back of the throat, like the soft palate (the back end of the roof of the mouth), the uvula (tiny appendage that hangs down), tonsils, adenoids, become flabby and vibrate with the airflow, causing the various classical noises of snoring. They also cave in and out (like a floppy valve) with respiration, blocking the upper airway and causing sleep apnea.

Does singing lessen snoring?

Singing helps tone the flabby muscles of our upper airways, the soft palate, in particular. Singing exercises for 20 minutes a day appear do the trick for some. Belting out a few songs, even off key, everyday in the family room or in the shower might annoy your house mate, but it will at least please her in bed every night when you snore less.

Does a person snore more after sex?

As we have in a previous article studies show that people who snore (more so among men) snore more and louder after sex. Following the act, the partners, especially the male, who is usually the more dominant one, gets so tired, relaxed and sleepy. When this happens, the body as a whole (and the upper airway muscles in particular) become relaxed and "flabby" that the breathing causes exaggerated vibration of the soft palate and uvula, resulting in louder snores. Sex does not cause snoring among those who do not snore to begin with.

Are "snore stoppers" effective?

"Snore aids" advertised in the various media, such as nostril clips, nasal or throat sprays, magnetic wrist bands do not work to stop snoring, much less cure sleep disorders. Only those fraudulent vendors who make bundles of money by duping the ignorant public could sleep well, minus their conscience. One contraption, the jaw sling, which prevents the jaw from dropping while the person is asleep, shows promise for some snorers, but uncomfortable to wear.

What is the non-specific therapy?

Weight loss for those who are overweight can minimize the episodes of sleep apnea. Avoidance of sleeping pills, sedatives and alcohol, all of which increase the frequency and duration of sleep apnea, is most essential. Lying flat on the back induces sleep apnea for a lot of people. This could be avoided by placing a pillow at the back and lying on the side.

What are the various treatment regimens?

The three modalities are: (1) Physical or Mechanical, (2) Surgery, and (3) Non-specific therapy. The specific prescription depends on the medical examination and laboratory findings. The physical or mechanical treatment works only when used as the patient sleeps and apnea returns when the regimen is not utilized. There are two forms: Continuous Positive Airway Pressure (CPAP) and Dental/Oral Appliances. CPAP, the most commonly prescribed, uses a snugly fitted face mask where continuous positive pressure air is blown into the nose, forcing the airway to stay open for proper breathing. Dental/oral appliance, which is fitted by an ortho dentist, uses a device that moves the lower jaw forward to cause an under bite, which opens the airway.

What is the surgical treatment?

Surgery removes tissues, like nasal polyps, adenoids, tonsils, and any oro-pharyngeal deformities that causes obstruction to airflow. One of them is called uvulopalatopharyngoplasty, which excises tissues at the back of the throat. The success rate is low, between 30-60% and it is hard to know which patients will benefit from it, side effects and eventual outcome. The others are tracheostomy (creating a hole in the windpipe for those with severe obstruction, which is not too common), surgical reconstruction for those with deformities, and surgery to treat obesity, which contributes to sleep apnea.

What medical conditions contribute to sleep disorders?

There are many impairment of sleep due to a variety of medical ailments, like emphysema congestive obesity, heart failure, diabetes, stroke, and others conditions associated with pains like cancer, arthritis, acid reflux in the esophagus (food pipe). Anxiety disorders and depression are also associated with sleep disturbances. Consultation with a sleep specialist is critical for proper diagnosis and treatment these disorders.

©2003Raoul R. Diez, M.A.O.D.