DO YOU SNORE LOUDLY?
Are you the target of bad jokes or middle-of-the-night elbow thrusts? If this sounds familiar, you may already know that snoring is no laughing matter.
LOUD SNORING can be a sign that something is seriously wrong with your breathing during sleep. Snoring indicates that the breathing passage in your throat is not fully open, and the distinctive sound of snoring comes from trying to force air through this narrow area.
An estimated 10 - 30% of adults snore. In most, snoring has no serious medical consequences. For about 5 in 100 people, however, loud nightly snoring is an important sign of a serious disorder: obstructive sleep apnea (OSA).
WHAT is Obstructive Sleep Apnea?
"IF YOU HAVE OSA, YOU MAY NOT GET ENOUGH OXYGEN DURING SLEEP AND PROBABLY DON'T SLEEP SOUNDLY."
The muscles that stiffen and open the throat tend to relax during sleep in normal children and adults. This relaxation leads to slight narrowing of the throat that does not cause a problem for most people. However, in people with OSA, this narrowing of the breathing passage is so great that breathing becomes difficult, as if they were breathing through a floppy, wet straw. The sleeping brain senses that breathing is difficult and increases the effort to breathe. Eventually, this increased effort awakens the brain, which signals the throat muscles to become active again and then reopens the breathing passage. With the breathing passage once more open, the effort to breathe decreases and the person goes back to sleep. This cycle of falling asleep, throat narrowing, increased effort to breathe and then arousal from sleep tends to repeat itself throughout the night and can disturb sleep dozens to hundreds of times each night. Most of these awakenings are so brief that they are not remembered the next morning. And individual with this pattern of obstructed breathing, brief awakenings from sleep, and daytime symptoms is said to have OSA.
WHAT Causes Obstructive Sleep Apnea?
Since the throat muscles relax to some extent during sleep in everyone, many patients with OSA have additional factors that contribute to throat closure. These include a smaller-than-normal jaw, large tongue, enlarged tonsils, or tissues that partially block the entrance to the breathing passage. OSA often occurs in overweight people, as it is thought that extra fatty tissue in the neck affects the size or shape of the breathing passage. Sometimes several of these conditions are present in the same person.
Since OSA is less frequent in younger women, a different throat structure or certain female hormones may protect them from having the disease, although in later years and especially after menopause the gap between the sexes narrows.
Alcohol, sleeping pills, and tranquilizers taken at bedtime also relax these muscles and can make the breathing passage more likely to close. Some people with OSA may have worse sleep when they take a sleeping pill, or these pills can even be dangerous for them. If your health professional prescribes a sleeping pill for you, make sure that you tell him or her about any symptoms of OSA you might have.
"FOR ABOUT 5 IN 100 PEOPLE LOUD NIGHTLY SNORING IS THE FIRST SIGN OF A SERIOUS DISORDER."
There is more than one kind of throat closure in OSA. The breathing passage can narrow so much that no air can get through (apnea) or a bit less so that some air can pass (hypopneas). In some patients, the narrowing may be so slight that the body can keep breathing normally by increased effort, but this may still cause repeated awakenings (respiratory effort related arousals or upper airway resistance syndrome). It is thought that all of these events lead to the same consequence: sleep disruption. Most sufferers will have a combination of the different types of abnormal breathing. In addition, airway closure may drop the level of oxygen in the blood, which can cause additional symptoms.
If you have OSA, you may not get enough oxygen during sleep and probably don't sleep soundly. You may suffer from sleepiness that affects your work and/or social activities, and that could even lead to car accidents. OSA can also put you at risk for high blood pressure, heart failure, heart attack or stroke. If you snore loudly on most nights, you should visit your healthcare professional. He or she may suggest evaluation at a sleep disorders center. Fortunately, sleep specialists are now able to diagnose and treat these breathing disorders during sleep. Proper treatment can prevent or reverse the potentially dangerous consequences of OSA.
WHAT are the Warning Signs of OSA?
These problems usually appear slowly and progress over many years, so that the patient may not recognize the symptoms. Sometimes the patient thinks the symptoms are just from getting older or are not serious. Family members, employers, or coworkers may be the first to recognize a pattern of excessive sleepiness and/or changes in mood or behavior, and should encourage a visit to a healthcare professional.
- Excessivly loud snoring which can be heard rooms away (or even by neighbors).
- A pattern of snoring interrupted by pauses, then gasps, is a sign that breathing stops and restarts. Occasionally, patients will remember waking up short of breath or gasping, although the vast majority of episodes are not recalled.
- Falling asleep at the wrong times, such as at work or while driving.
- Trouble concentrating, or becoming forgetful, irritable, anxious, or depressed.
- Morning headaches or nausea, frequent trips to the bathroom to urinate at night, and loss of interest in sex. Men may complain of impotence and women may have menstrual irregularities.
WHAT Happens if I am not Treated for OSA?
The most common complaint of people with OSA is excessive sleepiness. The sleepiness is most often felt when the person with OSA is sitting still or not active either physically or mentally. He or she may be unable to remain awake or to concentrate while reading or watching TV, even if they are interested in the material. Driving an automobile can often be difficult because of unwanted sleep, and people with OSA have more automobile accidents due to dozing or inattention. Untreated OSA has other consequences for health and well-being. A list of some of those can be found above.
Medical science is learning that the treatment of OSA can reduce or eliminate these risks. In many cases, the patient feels the benefits, such as reduced sleepiness and better mood, quickly after treatment begins.