Otolaryngology Services

Snoring, Sleep Apnea and Your Health by Ashish K. Wadhwa, MD

As an Ear, Nose, and Throat physician, one of the things that I am called upon rather frequently for is the management of snoring. While some might even find it somewhat laughable to think of seeking medical treatment for a social taboo, you may be surprised to learn snoring can be a sign of serious diseases to come.

Approximately 45 % of the U.S. population snores. While snoring alone may lead to social isolation (being kicked out of your bedroom), in of itself, it is fairly harmless to the individual who is snoring. Snoring is simply the vibration of tissue in the throat as air passes through it. During the daytime, our muscles are awake and this keeps the throat open so that this vibration does not occur. When we go to bed at night, particularly during the deep stages of sleep, a relaxation of most of the body's muscles will occur, including those around your throat. Gravity is now allowed to let extra tissues in the throat drop backwards, and as the air passes through the throat, the excess tissue will vibrate and make the snoring sound.

The excess tissues in the throat can mean a variety of things. In a heavier person, this may be the bulk of muscle from the tongue. In a person with large tonsils, it may be the tonsils themselves. If you have a long uvula (the dangly thing in the back of your throat), it may be vibrating with the palate while you sleep. Oftentimes, it is a combination of all of these things. Sometimes the tissues of the throat are fine, but the nose breathing passages are fundamentally small. If you have ever tried to drink a thick milkshake with a small straw before, you know the straw will collapse. Likewise, if the throat keeps collapsing while sleeping, the tissues will vibrate and you will snore.

Taken to the extreme, if you snore and your throat collapses for a prolonged period of time, you will periodically stop breathing. In medical terms, going without breathing is called apnea- hence "sleep apnea". Sleep apnea is a serious problem. If you periodically stop breathing whenever you go into the deep stages of sleep, your body and brain are obligated to prevent you from going into the deep stages of sleep. Unfortunately the deep stages of sleep are the ones most needed for our body to get properly rested. Hence, sleep for a patient with sleep apnea is not restful, and a person with sleep apnea feels tired during the day despite sleeping at night time. Such a person tends to nod off when things slow down, because the body is craving sleep whenever it can.. Because the person is tired, they exercise less, gain weight, only exacerbating the initiating problem. Even worse, because the person's body still tries to get the deep sleep it is craving, during sleep it goes in and out of the deep sleep dropping body oxygen levels briefly to get rest, but then arousing itself on a subconscious level to get a breath, only to repeat the cycle over and over through the night.

Many people function well enough despite their sleep apnea, and are completely unaware of the process going on at night time. The signs then are the ongoing fatigue, feeling unrefreshed in the mornings, or the witness of cessations of breathing by their bed partners at night time. Tendency to nod off during meetings, watching TV, or movies is also noticed by some who are deprived of restful sleep. Untreated severe sleep apnea may even lead to nodding of while driving, which is obviously unsafe for everyone in the community and the person with sleep apnea. Long-term untreated sleep apnea causes the heart and lungs to work harder at night time, leading to heart and lung disease over the course of years.

Treatment for snoring involves a range of options from weight loss (if overweight), avoiding sleeping on your back, avoiding drinking alcohol at night, to surgical options. Surgical options including modification of the nose, throat, palate, tonsils, or tongue base, each of which has to be tailored to each individual patient's anatomy.

Diagnosis of sleep apnea and its separation from snoring alone, requires a medical evaluation and possibly a sleep study. A sleep study is an assessment either in your home or in a sleep laboratory where you are observed and monitors are placed on you to assess your stage of sleep, oxygen level, and frequency of breaths, amongst other things, to assess whether there is a significant problem. Treatment includes those things discussed above , in addition to the possibility of using a continuous positive airway pressure (CPAP) machine which helps to maintain an open throat by application of air pressure through a face mask. Surgical treatment options are also available, and this is again tailored to the individual patient's anatomy and disease severity.

If you wish to learn more about snoring, sleep apnea, or your Ear, Nose, and Throat health, please contact your physician or contact our office.

Snoring and Sleep Apnea

Forty-five percent of normal adults snore at least occasionally, and twenty-five percent are habitual snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age. Snoring occurs when floppy tissue in the airway relaxes during sleep and vibrates. Most snoring is caused by an enlarged soft palate and uvula at the back of the mouth, although the tongue, tonsils, adenoids and congested nasal passages can also contribute to the sound.

Snoring can also disturb sleep patterns and deprive the snorer of appropriate rest. When snoring is severe, it can be associated with long-term health problems, including obstructive sleep apnea. A chronically snoring child should be examined by an ear, nose, and throat specialist for problems with his or her tonsils and adenoids. A tonsillectomy and adenoidectomy may be required to correct the problem. For many adults, non-surgical approaches include weight loss and other lifestyle modifications or the use of an oral appliance to reposition the jaw during sleep. A variety of surgical treatments are also available to reduce the excess tissue.

Differences between snoring and sleep apnea

Snoring is a loud sound that a person makes as they breathe during sleep. Sleep apnea is a breathing obstruction that requires the sleeper to awaken to begin breathing again. A person with sleep apnea wakes up many times a night to regain breathing. Snoring is a common symptom of sleep apnea. Snoring by itself does not involve the cessation of breathing.

Nature of sleep apnea

Sleep apnea causes a person to stop breathing periodically throughout sleep, which upsets the balance of oxygen and carbon dioxide in the blood. The brain senses the reduction in oxygen and the increase in carbon dioxide and sends a signal to resume breathing. The person wakes up in response to the breathing arousal signal from the brain. The muscles of the tongue and throat awaken to enlarge the airway and allow carbon dioxide to escape and oxygen to enter. The waking episodes are necessary to restart breathing, but they prevent the individual from getting high-quality sleep.

On a physical level, the sleep apnea sufferer cannot breathe because they have an obstructed airway. The throat muscles and tongue relax too much and may be enlarged or misshapen, so the air passage is narrowed during sleep.

Sleep apnea sufferers awaken frequently to restart breathing, but they remember little or nothing of being awake. Frequent waking at night may be a sign of sleep apnea. One measure of sleep apnea is that the person must stop breathing for a period of at least ten seconds or more, five times within an hour. Sleep apnea sufferers may stop breathing for as long as two minutes.

If you snore and also have other signs of disrupted sleep like excessive daytime sleepiness and headaches, you might be experiencing sleep apnea. Ask yourself the following questions. If you answer yes to any of them, you should consult your otolaryngologist.

Do you snore on a regular basis?

Do you ever wake up suddenly, gasping or choking for air?

Do you experience excessive sleepiness during the day? Do you often have trouble staying awake, even when occupied?

Do you experience headaches, sore throat, or dry mouth in the mornings after waking up?

Sleep apnea is a dangerous sleep disorder that worsens with age. Not only does sleep apnea result in sleep deprivation, but it can also be life threatening.

Signs and symptoms that can alert you to sleep apnea are:

• Frequent cessation of breathing (apnea) during sleep
• Choking, gasping, or gagging during sleep to get air into the lungs
• Loud snoring
• Sweating during the night
• Feeling unrefreshed in the morning
• Headaches upon awakening
• Daytime sleepiness
• Lethargy
• Rapid weight gain
• Memory loss and learning difficulties
• Short attention span
• Poor judgment
• Depression
• Personality changes