About 30 to 40% people snore at sometime or other. People who snore loudly are often ridiculed, but truly speaking snoring is not a laughing matter. While loud disruptive snoring is a known social problem that may strain relationships, for many men, women and even children, loud habitual snoring may signal a potentially life threatening disorder: obstructive sleep apnea, or OSA.What is Obstructive Sleep apnea or OSA:
In people who snore sometimes breathing ceases or gets interrupted for few seconds before regaining the normal pattern. These breathing pauses typically last between 10 to 20 seconds and are known as apnoec spells and can occur up to hundreds of times a night, jolting you out of your natural sleep rhythm. Sleep apnea is fairly common. One in five adults has at least mild sleep apnea and one in 15 adults have at least moderate sleep apnea. OSA also affects 1% to 3% of children. During sleep, the upper airway can be obstructed by excess tissue, large tonsils and/or a large tongue. Also contributing to the problem may be the airway muscles, which relax and collapse during sleep, nasal passages, and the position of the jaw. As a consequence, when you get up in the morning you feel groggy and no longer feel fresh. Unlike simple snoring, obstructive sleep apnea is a potentially life-threatening condition that requires medical attention. The risks of undiagnosed OSA include heart attack, stroke, irregular heartbeat, high blood pressure, heart disease and decreased libido. In addition, OSA causes daytime drowsiness that can result in accidents, lost productivity and interpersonal relationship problems. The symptoms may be mild, moderate or severe.Sleep apnea signs and symptoms:
It is not possible for the person to notice sleep apnea. He or she should ask the bed partner to observe his/her sleep habits, or by recording oneself during sleep.Major signs and symptoms:
- Loud and chronic snoring
- Choking, snorting, or gasping during sleep
- Long pauses in breathing
- Daytime sleepiness, no matter how much time you spend in bed
- Getting up with a dry mouth or sore throat
- Morning headaches
- Restless or fitful sleep
- Insomnia or frequently getting up at night
- Going to the toilet frequently at night
- Loss of memory & lack of concentration
OSA is also commonly seen in children who are obese or who have adenoids and tonsillar hypertrophy. Children with sleep apnea may adopt strange sleeping positions and suffer from bedwetting, excessive perspiration at night, or night terrors. Children with sleep apnea may also exhibit changes in their daytime behavior, like:
- Hyperactivity or inattention
- Developmental and growth problems
- Decrease in school performance
- Irritable, angry, or hostile behavior
- Breathing through mouth instead of nose
Not everyone who snores has sleep apnea, and not everyone who has sleep apnea snores. So how do you differentiate snoring and a more serious case of sleep apnea? The biggest telltale sign is how you feel during the day. Normal snoring doesn't interfere with the quality of your sleep as much as sleep apnea does, so you're less likely to suffer from extreme fatigue and sleepiness during the day.When should you consult your doctor
If you are a habitual snorer and you are having few of those above mentioned signs and symptoms then you should immediately consult your family physician/ ENT Specialist.How is the diagnosis of OSA made?
When you visit your ENT specialist, you must go along with your spouse or bed partner, because he or she is the best witness of your sleep pattern. The Specialist will take detail history and will carry out thorough examination including cardio-vascular examination. You will be put through a whole night sleep study or "Polysomnography" during which your various parameters like pulse rate, blood pressure, ECG, apnoec spells(spells of breathing interruption), fall of blood oxygen saturation etc; are recorded and analysed.
Based on the sleep study results it is decided whether one is having OSA or not.Some non medical remedial measures for reducing snoring:
- Weight loss - as little as 10 pounds may be enough to make a difference.
- Change of sleeping position - Because you tend to snore more when sleeping on your back, sleeping on your side may be helpful.
- Avoid alcohol, caffeine and heavy meals - especially within two hours of bedtime.
- Avoid sedatives - which can relax your throat muscles and increase the tendency for airway obstruction related to snoring.
- Prop your head up - Elevate the head of your bed by four to six inches or elevate your body from the waist up by using a foam wedge. You can also use a special cervical pillow.
Initially the non medical measures are advised. If still the patient does not get relief the there are two options:
- Polysomnography / Sleep study
- (a) Non surgical option i.e. use of Continuous Positive Airflow Pressure (CPAP) or Bi-PAP (Bi-Level) machine while sleeping.
- Laser assisted Uvuloplasty
- Coblation assisted UPP.
- Radio Frequency assisted soft palate reduction
- In case of children simple adeno-tonsillectomy or nasal septoplasty
During sleep, brain is highly active. It regulates immune, hormone and endocrine functions. Good sleep is essential for general health; it ultimately restores good memory, learning process, problem solving ability and creativity. Most adults sleep 6 - 8 hours in the nighttime and duration varies from individual to individual. Sleep less than 4 hours and more than 9 hours have bad effects on the health. During sleep we go through NREM (Non rapid eye movement) and REM (Rapid eye movement) stages.
Sleep deprivation due to snoring leads to daytime sleepiness. This dangerous medical condition often goes undiagnosed and people are unaware about the consequences.
Recent study shows that 34% of the male and 10% female are habitual snorers. Intermittent snorers, 56% are male and 30% are female. Snoring increases with the age. As snoring leads to daytime sleepiness, in India one out of 19 Indians go to sleep when they are sitting. Obviously they are suffering from Sleep Apnoea.
Obese men are more prone for snoring and may have Obstructive Sleep Apnoea (OSA) and more prone to Heart attack.
If somebody snores excessively during sleep, we have feeling that his sleep is nice and symbol of happy person. Now, you should not take snoring during sleep lightly. In long run he or she may suffer from Sleep Apnoea which have many known, recognized and unrecognized like threatening consequences.
Untreated cases can lead to uncontrolled hypertension mostly in young age and can have arrythmias ultimately causing heart attack and stroke.
There is increased risk for Diabetes, Thyroid dysfunction, Obesity, Acidity, Impaired concentration and memory leading to daytime sleepiness. These people, because of daytime sleepiness and lack of concentration, are more prone for automobile accident, accident at work places, financial losses and loss of work.
Snoring leads to pauses in the breathing called as "Apnoea". During apnoea patients are without breathing. These pauses "Apnoea" can be for 10 seconds to 1 or 2 minutes in duration. These pauses are potential risk to the life and if not, can cause lots of metabolic changes in the body, like irregular heartbeats, changes in the blood pressure, oxygen de-saturation i.e., less oxygen being provided to brain, heart and other body tissues. Oxygen de-saturation or more carbon dioxide accumulation in the body is potential risk to life.In OSA what happens during the night sleep
- Snoring during sleep
- Apnoeic pauses during breathing
- Gasping or chocking during sleep
- Fragmented sleep
- Excess urination during night
- Excessive perspiration during sleep
- Fragmentation and loss of architecture of sleep
- Morning tiredness and Headache
- Needs nap during day
- Memory loss and poor concentration
- Impaired daytime performance
- Irritability and moodiness
- Depression, change of personality
- Chest pain, Breathlessness
Mostly in snorers and obese peoples, during sleep, muscles, which control the tongue and soft palate, become relaxed and the upper airway can, become completely blocked and prevent the normal breathing.Risk factors for Sleep Apnoea
- History of snoring
- Increased neck circumference
- Family History
- Narrowed upper airways
In one of the current study in USA, 28% of the truck drivers were found to have mild sleep apnoea. As the automobile accidents are more common in sleep apnoea patients, drivers need to be routinely screened for both, sleep apnoea and for the impaired performance.
In India it is seen that 3.6 % of the Indian Population (36 million people) suffer from sleep apnoea. Millions of Indian may not be aware about this problem and condition, which may have life threatening effects on their health. Sleep apnoea can cause high blood pressure, heart attack, stroke, psychological problem, obesity, compromised immune system and risk for accidents.
Good sleep or sleep hygiene can make this patient comfortable up to some extent.
- Adopt healthy and athletic life style
- Avoid sleeping tablets
- Stop tobacco chewing
- Stop Bidi / Cigarette smoking
- Discourage alcohol
- Maintain sleep hygiene as regular schedule
- Set aside worries
- Keep sleeping room cool, dark, quiet
Many of the features and interview with patients & spouse or partner along with physical examination can make the diagnosis obvious. But the gold standard for the diagnosis is still Polysomnography or sleep study.
Polysomnography or sleep study is performed during the night time and it gives idea about the severity of OSA, whether it is mild, moderate or severe, apneas are centrally origin or obstructive in nature. Severity of snoring, severity of apneas, heartrate, body oxygen saturation, body movement, chest and abdominal movements, effects of sleep apnea on brain, heart and various parts of the body is recorded during sleep study. It is helpful in rectifying the defects.
Overall 90% of the people suffering from sleep apnoea do not know what problem they have.
Usually a bed partner first notices it. Once the diagnosis is made then they are treated with surgical management or non-surgical management like CPAP.Health Consequences of Sleep Apnoea
- Chronic sleep deprivation
- Excessive daytime sleepiness
- Increased Motor vehicle accident
- Poor job performance
- Increased work related accident
- Family discord
- Decrease in quality of life
- Impaired cognitive function
- Decreased survival
- Study reports that natural death during sleep in elderly may be associated with sleep apnoea
- Strong relationship between sleep apnoea & heart failure
- Strong relationship between sleep apnoea & essential hypertension, Diabetes Mellitus
- Sleep Apnoea is risk factor for development of stroke
- This patient also have risk during Anaesthetia, during Surgery & during Recovery period from surgery
In summary it is always better for snorers to get their health check up for sleep apnoea at sleep study centers and take early measures to prevent further complications and consequences for sleep apnoea.