Snoring is usually a minor affair, though it can be a source of strife between bed partners or roommates. Of greater concern, it can be a symptom of a serious disorder called obstructive sleep apnea.
Estimates vary widely, but it’s likely that sleep apnea affects about 10 percent of all adults. Rates have been rising steadily in the past 20 years, largely because of the obesity epidemic. The great majority of people with sleep apnea do not know they have it.
Sleep apnea: a lot of night music
If you have sleep apnea, your bedmate may tell you that you saw logs all night and that you often stop breathing (for anywhere from a few seconds to more than a minute), sometimes followed by choking and gasping to recover—a pattern that may be repeated hundreds of times a night. It’s like someone waking you 10 to 30 times an hour, though you may not even be aware of it.
Sleep apnea is caused by a temporary blockage of the throat’s breathing passages. The soft tissue at the back of the mouth vibrates during snoring, but with apnea the tongue and other soft tissues periodically fall back and totally block the airway. Sometimes the airway is only partially blocked, resulting in very shallow breathing. In either case, oxygen levels in the blood fall, and carbon dioxide rises. Your throat muscles contract as you struggle for air, you gasp or snort loudly, then you start breathing again (because your brain wakes up briefly) and fall back to sleep, until the cycle starts again.
Apnea is more common in men, especially black and Asian men, though recent research has found it is surprisingly prevalent among women, too, especially after menopause. Obesity greatly increases the risk, as a result of excess soft tissue in the throat. Having a thick neck, in particular, makes it more likely that the airway will collapse during sleep. Though not everyone who snores has apnea, loud snorers are most likely to have it. Increasing age, family history and certain anatomical abnormalities also increase the risk. In addition, heavy drinking, smoking and sedatives can promote apnea.
By robbing you of restorative sleep, apnea leads not only to daytime drowsiness, but also to irritability, faulty memory, inability to concentrate, headaches and possibly depression and decreased libido. Especially dangerous: People with sleep apnea are at high risk for falling asleep while driving.
Sleep apnea's other risks
Sleep apnea is known to cause hypertension and increases the risk of heart disease, stroke, diabetes, depression, osteoporosis, glaucoma and premature death. Recent research has linked it to chronic inflammation, which is associated with cardiovascular disease and many other disorders. What’s more, it can cause serious complications during and after surgery.
In June the American Academy of Sleep Medicine advised that all people with type 2 diabetes or hypertension be evaluated for sleep apnea. Fortunately, many studies have found that when sleep apnea is a contributing factor, treating it (notably by losing weight or using a CPAP machine, see below) helps improve these diseases. According to a recent study from the University of Chicago, for instance, a CPAP machine can control blood sugar levels as effectively as drugs in some people with type 2 diabetes.
Sleep apnea: getting diagnosed
If you don’t sleep well and snore, talk to your doctor, particularly if you have hypertension or diabetes or are significantly overweight. If it seems that you may have sleep apnea, you should be referred to a board-certified sleep specialist. Based on this evaluation, further sleep testing may be recommended, either at a sleep clinic or with a home monitoring device. Such devices use a headset and/or nose, finger, or other sensors to record physiological changes during sleep.
Apnea do’s and don’ts
If you’ve been diagnosed with sleep apnea, the following steps should help. They can also help with regular snoring.
- If you’re overweight, lose weight.
- Limit or avoid alcohol, especially in the evening.
- Avoid sedating medications such as narcotics, sleeping pills, anti-anxiety drugs and some antihistamines.
- Avoid heavy meals in the evening.
- If you smoke, stop.
- Try sleeping on your side, 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.
- Forget about those inexpensive over the counter oral devices—they don’t work and can cause mouth and jaw discomfort.
Published October 01, 2013