Snoring, as common as it is, may be a sign of a serious, treatable condition - obstructive sleep apnea (OSA). Sleep disorders including OSA, insomnia, restless leg syndrome, effect more than 50 million Americans. Unfortunately most suffers are aware that help is available.
All snorers have incomplete obstruction (blockage) of the upper airway. People with OSA have episodes of complete upper airway obstruction resulting in a period of silence usually 10 seconds or longer - an episode of apnea (breathlessness). The silence is usually followed by snorts and gasps as the individual fights to take a breath. When an individual snores so loudly that it disturbs others, obstructive sleep apnea is almost certain to be present.
Primary Snoring, also known as simple snoring, snoring without sleep apnea, noisy breathing during sleep, benign snoring, rhythmical snoring and continuous snoring is characterized by loud upper airway breathing sounds in sleep without episodes of apnea (cessation of breath).
What is Sleep Apnea?
OSA characterized by frequent episodes (may be hundreds of times nightly) of upper airway obstruction that occur during sleep that usually is associated with a reduction in blood oxygen saturation. In other words, the airway becomes obstructed at several possible sites. The upper airway can be obstructed by excess tissue in the airway, large tonsils, a large tongue and usually includes the airway muscles relaxing and collapsing when asleep. Another site of obstruction can be the nasal passages. Sometimes the structure of the jaw and airway can be a factor in sleep apnea.
- Daytime sleepiness
- Sleep partner may report patient seems to gasp for air during the night
- Headache upon arising
- Dry mouth
The risks of undiagnosed obstructive sleep apnea include heart attacks, strokes, impotence, irregular heartbeat high blood pressure and heart disease. In addition, obstructive sleep apnea causes daytime sleepiness that can result in accidents, lost productivity and interpersonal relationship problems. The severity of the symptoms may be mild, moderate or severe.
Primary care physicians, from the patient's history frequently identify sleep disorders. However, to appropriately characterize the exact nature and severity of disease, polysomnography (sleep study) is the current standard of care. Physicians specializing in sleep medicine are the most appropriate individuals to order and interpret sleep studies.
A sleep studies involves observation of a patient overnight utilizing monitors that record heart rate, blood oxygen content, respiratory rate, chest movement and other parameters. The sleep specialist utilizes the information obtained to diagnosis and design treatments.
Mild Sleep Apnea is usually treated by controlling behaviors that aggravate the condition: weight loss, reduce alcohol consumption and sleep on your side is often recommended. There are oral mouth devices (that help keep the airway open) on the market that may help to reduce snoring in three different ways. Some devices (1) bring the jaw forward or (2) elevate the soft palate or (3) retain the tongue (from failing back in the airway and blocking breathing). Sleep Apnea is a progressive condition that gets worse as you age and should not be taken lightly.
Moderate to severe Sleep Apnea is usually treated with a C-PAP (continuous positive airway pressure). C-PAP is a machine that blows air into your nose via a nose mask, keeping the airway open and unobstructed. For more severe apnea, there is a Bi-level (Bi-PAP) machine. The Bi-level machine is different in that it blows air at two different pressures. When a person inhales, the pressure is higher and in exhaling, the pressure is lower. Your sleep doctor will "prescribe" your pressure and a home healthcare company will set it up and provide training in its use and maintenance. Often, a repeat sleep study will be necessary to insure that the appropriate level of C-PAP or Bi-PAP is utilized to reduce if not eliminate apneic episodes.
Many patients cannot or will not tolerate C-PAP or Bi-PAP. There are surgical alternatives:
- Uvulopalatopharyngoplasty (UPPP) or
- Laser-Assisted Uvulopalatoplasty (LAUP) involves removing excess tissue from the throat.
- Somnoplasty uses radio frequency waves to remove excess tissue.
Some people have facial deformities that may cause sleep apnea. It simply may be that their jaw is smaller than it should be or they could have a smaller opening at the back of the throat. Some people have enlarged tonsils, a large tongue or some other tissues partially blocking the airway. Fixing a deviated septum may help to open the nasal passages. Removing the tonsils and adenoids or polyps may help also. Children are much more likely to have their tonsils and adenoids removed.
There are several other surgical treatments. Usually a surgeon will ask the patient to be on CPAP for at least month to see if they gel better. If CPAP cannot help then surgery is probably not the right thing to do.
Sleep disorders can dramatically impair quality of life and can precipitate catastrophic events. Most sleep disorders respond to carefully designed therapies. If you or a loved one suffers help is available through sleep specialists throughout the country. Visit our physician locator for network sleep specialists in your area.
For additional information on sleep disorders, visit these sites:
- American Sleep Disorder Association
- Narcolepsy Network
- National Sleep Foundation
- Penn State Sleep Lab - Great Stuff
- Sleep Net
- Sleep Neural Home Page
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