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Roughly a third of people--10-20% of young adults under 40 and 40-50% of older adults over 60--are snorers, which means they are making an audible sound from soft tissue that vibrates somewhere in the airway during sleep. Snoring is so common, yet a source of social embarrassment for many who prefer not to believe they do it. More than a source of embarrassment, snoring can be a cause of poor sleep and subsequent development of repeated, excessive daytime sleepiness. It has been known ever since sleep laboratories were established in the 1970's that snoring can cause brief awakenings that lead to very fragmented sleep. Fragmented sleep prevents the development of deep and replenishing sleep and may evolve, over time, into a daytime pattern of memory problems, slow thinking, bad decision-making, irritability, and depression due to accumulated sleep debt. A related chronic insomnia can develop in a snorer's sleeping partner who hears and is aroused nightly by the snorer.
Just as important as identifying the extent of sleep interference that a snoring person experiences is the establishment of whether or not the snorer has apnea. Apnea is defined as the cessation of breathing for more than 10 seconds at one time. Everyone may have occasional apneic episodes during sleep, but its repeated occurrence (30 or more times in a night) can be very disruptive to a night's rest. The actual length of an apneic episode is quite variable and may last more than a minute. The cause of stopping to breathe during sleep is most often a block of airflow when a vibrating tissue--a normal structure in the mouth, nose, or throat--blocks the breathing passageway. In adults, one of the common mechanisms of narrowing the passageway is weight gain, whereby there is simply not as much room to accommodate all the anatomic structures. In a reclining position, particularly laying on the back, the tongue may fall back and narrow the airway, causing positional apnea. Another type of apnea that occurs less commonly than the obstructive type is central apnea, whereby the brain somehow ceases to incite the breathing muscles to work for prolonged periods.
In both obstructive and central types of apnea, there is such a change in the apneic person's oxygen and carbon dioxide blood levels as each episode continues that breathing eventually is restored, but there is a price. The brain is temporarily put on alert during each prolonged apnea, and this alert leads to a brief awakening over and over again that results in less effective, less consolidated sleep. The apneic person often awakens feeling tired even after what seems a lengthy sleeping period. He or she is puzzled, not aware that these events have affected the sleep quality. As the day wears on, particularly after this problem has lasted for months to years, fatigue is a constant presence. Sometimes a nap seems briefly replenishing, but if there is sufficient apnea during the nap it too is less than ideally effective. Ultimately, the sleep-deprived person is aware that in virtually any situation without constant brain stimulation, the need to sleep is interfering with a quality life.
A doctor in the sleep lab is adjusting one of the measurement electrodes to monitor brain waves during a sleep test.
How can a snoring problem be studied?
Fortunately, we now have a very good way of evaluating sleep disorders like snoring and apnea. We can determine just how severe the problem is and, fortunately, we now have ways to provide proper treatment. For evaluation, it is recommended that persons with sleeping problems of this nature should be evaluated in a sleep clinic that has the proper equipment and personnel licensed to study sleep. The formal sleep study is called a polysomnogram. Overnight, the person with the problem is observed and connected to a number of measuring systems. The measurements tell the amount of breathing, the loudness and frequency of snoring, the level of oxygen in the blood, and the brain waves during the night. The extent of muscle twitching and teeth clenching is also studied. In the end, a picture of the quality of the sleep is presented.
After a sleep study, the doctor counsels the person with a sleep problem on options for treatment.
Treatment of sleep apnea has evolved over the years. For some individuals, the best treatment is a small machine that connects to a hose that attaches around the nose. The device, known as a continuous positive airway pressure (CPAP) machine, is fit to the snoring and apneic person for use at home. A second option for the person with apnea is a surgical procedure performed by a surgeon who attempts to remove a portion of tissue that may be vibrating or to straighten a deviated structure, such as a nasal septum. Obstructing tissue may be removed by scalpel (knife), by laser, or another cauterizing tool that uses radio-frequency energy.
Treatment of snoring without apnea includes use of sprays, nasal dilators, position changes, and dental appliances. Sometimes snoring can be lessened or eliminating by treating another medical problem such as hypothyroidism. Sleeping pills, tranquilizers, and muscle relaxant medicines may be contributing to the snoring problem. In severe snoring, treatment may include options used for apnea, including surgery or CPAP.
Study of sleep problems has led to a much greater awareness of how quality of life can be affected by problems of snoring and apnea. If you believe you or your sleeping partner may have snoring or sleep apnea, it should be evaluated by a sleep expert. For further information you may wish to contact Dr. Scheer by e-mail.
Additional references on the subject of sleep apnea and snoring are:
"No More Snoring" by Drs. Victor Hoffstein and Shirley Linde, 1999.
"Phantom of the Night" by Dr. T Scott Johnson and Jerry Halberstadt, 1993.
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Copyright ©
1996-2005
Dr. Steven Scheer, MD. All rights reserved.
No part of this publication may be reproduced, downloaded, stored, or transmitted in any form or by any means, including copies or prints, written or oral, without prior permission in writing from the copyright proprietor.
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