Sleep apnea affects an estimated 10 percent of American adults, and rates have been rising, largely because of rising obesity rates. Most people with sleep apnea don't know they have it, but their bedmates or roommates know something is wrong. Not only do sufferers usually snore loudly, they stop breathing (for anywhere from a few seconds to more than a minute), then start to gasp and choke until breathing is restored—a pattern repeated many times during the night.
By robbing you of restorative sleep, sleep apnea leads to daytime drowsiness (especially dangerous when driving), irritability, faulty memory, and inability to concentrate. If that's not bad enough, it also causes many health problems, notably hypertension, as well as increasing the risk of heart disease, strokes, diabetes, depression, glaucoma, and other disorders.
Look in the mirror
Sleep apnea occurs when the tongue and other soft tissues at the back of the mouth periodically fall back and block the airway. When the blockage is partial, these tissues may audibly vibrate (snoring).
Along with obesity, the following structural abnormalities of the head and neck are associated with sleep apnea. What they all have in common is that they impede air flow.
- Large, fat tongue. It’s well known that a big tongue increases the risk of sleep apnea. A study in the journal Sleep found that increased fat not only makes the tongue larger but also impairs its muscle function, making it more likely to sag and block the airway.
- Small maxilla (upper jaw bone), relative to the rest of your face. This is a common cause of an underbite.
- Small mandible (lower jaw bone). This is a common cause of an overbite.
- Thick neck. A neck circumference of more than 17 inches in a man and 16 inches in a woman makes it more likely that the airway will collapse during sleep. Neck thickness is largely (but not totally) a result of obesity.
- Deviated septum. When the middle wall in the nose is crooked, nasal air flow may be impaired.
What you can do
If you snore and don't sleep well, having one of these abnormalities is all the more reason to consult your doctor, who may refer you to a sleep specialist.
If you are diagnosed with sleep apnea, you're likely to be advised as follows:
- If you're overweight, lose weight. Dropping even 10 or 15 pounds may help slim down your neck, tongue, and other excess soft tissue in and around the throat.
- You may be fitted for a mandibular repositioning device, which can pull your tongue and jaw forward while you sleep; the devices are custom-made by dentists who specialize in sleep apnea. Less expensive OTC oral devices are generally less effective and can cause mouth and jaw discomfort.
- Your doctor or sleep specialist may prescribe treatment with CPAP (continuous positive airway pressure), an air pump attached to a mask via tubing. This won't correct anatomical problems but is very effective at keeping your throat open while you sleep. There's also a prescription device called Provent, which may be a more manageable alternative to CPAP for mild sleep apnea. It is a patch with two small valves that you insert into your nostrils.
- If simpler measures fail, there are surgical treatments to reduce a large tongue, enlarge the airway, or correct a deviated septum, small maxilla, or small mandible.
Basic anti-apnea self-help steps
Limit or avoid alcohol, especially in the evening. Avoid sedating medications such as sleeping pills, anti-anxiety drugs, and some antihistamines. Avoid heavy meals in the evening. If you smoke, stop. Try sleeping on your side or stomach, not on your back (this helps keep your tongue from falling back and obstructing the airway). Elevate the head of your bed about six inches or elevate your torso using a foam wedge. Don't use a large pillow that forces your neck to bend.