| Another other major risk factor is alcohol use. Alcohol tends to selectively relax upper airway muscle tone, so it makes the upper airway more collapsible. This can also apply to sedatives such as some sleeping pills, particularly the type of sleeping pills we call the benzodiazepines, and some pain medications. Curiously enough, chronic sleep deprivation also tends to impact upper airway muscle tone.
You can also have a structural nasal problem, such as a deviated nasal septum or a narrow airway.
Are there any negative consequences associated with snoring?
There are some social consequences of chronic snoring that can impact on the intimacy of bed partners. If someone snores loudly and the bed partner is unable to sleep in the same room, that can certainly affect the quality of a relationship.
Sleep apnea is one of the significant consequences that is associated with snoring. If snoring goes on for a long period of time or the airway resistance is quite high, you can actually suck the airway shut. Not all patients with snoring have sleep apnea, but snoring is frequently associated with sleep apnea because both conditions tend to be associated with increased airway resistance.
The medical consequence of chronic snoring without sleep apnea is somewhat questionable at this time, though there are a number of studies now that have associated chronic snoring alone with increased risk of cardiovascular disease.
What are signs of sleep apnea?
Snoring is one of the cardinal signs of sleep apnea. We are frequently concerned about loud snoring that is usually punctuated by silence, which may represent an apneic event. This occurs when the airway is completely blocked and is frequently broken with a snort.
The other clinical clue associated with sleep apnea is the impact on daytime function. It's not uncommon for patients with severe sleep apnea to have an event almost every minute of sleep. Now people generally don't wake up in the morning and say, "Gee, I had 500 apnea events last night." But what people do wake up and experience is that "I feel like I didn't sleep well last night. It wasn't very restful experience."
What are the consequences of sleep apnea?
A significant outcome of sleep apnea is a low blood oxygen level. When there's an apneic event and the airway is no longer open, no carbon dioxide is being eliminated from the lungs and no oxygen is getting into lungs or the bloodstream. When the oxygen level in the blood drops, it can put stress on the body. This has been associated with some cardiovascular outcomes such as high blood pressure, stroke, heart failure and heart attack, as well as some rhythm disturbances with the heart.
Aside from that there's also been an association with automobile crashes in patients with untreated sleep apnea. Sleep apnea is also associated with mistakes on the job. White-collar workers may be slightly more affected than blue-collar workers because white-collar work tends to be more sedentary in nature.
How is sleep apnea diagnosed?
The clinical definition of sleep apnea is snoring, apnea and the complaint of daytime sleepiness. The diagnosis is confirmed with a sleep study in a sleep laboratory. Basically what we do is we monitor brain waves when people are awake and asleep and during different stages of sleep.
How is sleep apnea treated?
The medical treatment of choice for sleep apnea is a treatment called nasal CPAP (continuous positive airway pressure). Nasal CPAP is a mask that fits over the nose that's attached to a machine that generates positive pressure. By generating this positive pressure, you overcome the resistance in the airway and you offset the suction pressure associated with airway closure. By opening the airway, the patient needs to generate less suction pressure to bring in the air. When that occurs, the patient doesn't have airway closure or obstructive apnea. They don't have the sleep fragmentation that occurs at the termination of an apneic event. They maintain normal oxygen level during sleep, and they also improve sleep quality and continuity. The nasal CPAP devices are boxes that are generally less than 10 pounds. They're very durable, patients can travel with them. They're relatively easy to use and are have been shown to be particularly helpful in patients who are objectively sleepy during the day.
What other kind of treatment is available?
Usually what we consider for second-line therapy is surgery or oral appliances. Oral appliances are custom-made by dentists and can mechanically reposition the lower jaw forward, thereby increasing airway size and decreasing resistance. Overall, however, it's only about 50 percent effective for treatment of sleep apnea.
The reason physicians consider surgery second-line therapy is that it is not 100 percent effective. One surgical option involves trimming the uvula, the little thing that hangs down in the back of your throat, as well as some of the soft palate. The notion is that this decreases some propensity for airway blockage. The downside of this procedure is that while you may treat or cure snoring, you may not cure sleep apnea. So the patients can continue to have airway obstruction, but they obstruct in silence.
What advice do you have for lighter snoring?
There are many things that people can do to help themselves with regard to snoring. It would obviously be prudent—for a variety of reasons—to try and maintain a reasonable weight. Sometimes small amounts of weight loss can have a substantial effect on both snoring and sleep apnea. Number two is avoiding sleep deprivation. That's important because it not only affects snoring, but it also affects your general daytime function.
Number three is avoid alcohol and certain sedatives. And there is a misconception that a nightcap will help one fall asleep. While it may help one fall asleep initially, it puts one at risk for snoring and worsening of sleep apnea.
The last thing that people can do, if they have allergy problems, is to talk to their doctor about nasal congestion. Many patients feel that nasal congestion is not a significant medical problem, but if it's associated with snoring, it can be associated with altered sleep quality.
They can also quit smoking. These simple things can certainly help patients sleep better and be more productive during the day.
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