OSA AND SNORING

Sleep Apnea

Breathing Disorder During Sleep

Sleep apnea refers to non-breathing episodes during sleep, which may occur as frequently as several hundred times per night. Loud, irregular snoring occurs as the person attempts to breathe at the end of each apnea. Although you may have had a full night's sleep, you may still feel tired during the day.

Sleep apnea is a surprisingly common sleep disorder which can progress in severity and cause serious health problems if not detected and properly treated. The risk of developing OSA increases with advancing age and it is seen most commonly in overweight men.

Sleep apneas can cause serious health problems. With each apnea, oxygen content of the blood decreases causing blood pressure to rise and the heart to slow down. In order to resume breathing, the apnea sufferer will subconsciously arouse to regain muscle tone and open his or her airway. This strategy to breathe means that the individual’s sleep is frequently disrupted, causing daytime sleepiness. Sleep apnea can cause personality changes related to the sleep deprivation and has been associated with hypertension and an increased risk of heart attacks and strokes.

Three Types of Sleep Apnea

Obstructive Sleep Apnea (most common) is caused by a closing of the upper airway (blocking airflow) during sleep. Many factors can contribute to this blockage including nasal obstruction, enlarged tonsils, excessive tissue in the back of the throat and an enlarged tongue. During sleep, the airway muscles relax which contributes to this blockage. A person with OSA continues to try to breathe, but cannot pass air through the obstructed upper airway.

Central Sleep Apnea occurs when a person no longer tries to breathe. There seems to be no signal from the brain to keep breathing.

Mixed Sleep Apnea refers to a combination of central and obstructive apnea.

Diagnosis and Treatment

The diagnosis of OSA may be suspected, based upon a suggestive history and certain characteristics seen on physical examination by your physician. Proper diagnosis, however, can only be made by special monitoring of the individual’s sleep, by a polysomnogram.

Treatment for snoring and sleep apnea depends on what type of apnea you have and how serious it is. This information can only be obtained through a sleep study (polysomnogram or PSG). Based on the results of the sleep test, the physician can prescribe the appropriate treatment. This can be any of the following:

1. Behavior changes such as losing weight, avoiding alcohol and exercising regularly. Proper Sleep Hygiene is crucial.
2. A Continuous Positive Airway Pressure device (CPAP) that splints the airway open so one breathes steadily and normally. The flow of the air pushes on the collapsed tissues and muscles, leaving the airway open.
3. An oral device worn in the mouth to change the position of the jaw and tongue. This helps open the airway.
4. Surgery to increase the size of the upper airway (where obstruction occurs).

Air Pressure Devices

An air pressure device has a soft plastic (silicone) mask that fits around the nose. Wearing this mask may feel odd at first, but most people get used to it very quickly with some help from our Sleep Lab staff.

The most commonly used type of air pressure device is CPAP (Continuous Positive Airway Pressure). It literally blows air through the nasal passages and throat, keeping the airway open. Snoring is prevented. Breathing is maintained. This is the preferred treatment for most patients with significant OSA.

Snoring

People with sleep apnea often snore very loudly. But not everyone who snores has sleep apnea. If one snores, and then stops breathing, then makes snorting, gasping or choking sounds, one may have sleep apnea.

Find out what the snoring patterns are. Ask one’s bed partner to watch and take notes. If a bed partner is not available, set up a tape recorder.

These hints may quiet or lessen snoring:

Sleep in a lateral position. Sleeping on your back may increase snoring. Tissues in the throat block the airway causing snoring. These tissues are more likely to collapse downward when supine. To avoid this, sew a pocket or pin a sock on the back of a pajama shirt. Place a tennis ball in the sock. This will prevent rolling supine.

Clear your nose. Allergies and colds can block the nasal passages, increasing snoring and sleep apnea. Consider nasal sprays and humidity.

Avoid alcohol. This further relaxes the muscles in the throat, increasing the likelihood of collapse and airway blockage. When this happens, snoring and sleep apnea are worse.

Lose weight. Increased body mass leads to larger tissues in the nose and throat, increasing the chance of blocked airways, leading to snoring and sleep apnea. Exercise regularly.

Snoring may not be a problem for the patient, but it can be a problem for the bed partner, others in the home and sometimes even the neighbors!