Originally published in The Ottawa Citizen February 3, 2003
Original Title: Snoring your life away

Aside from the jokes and a partner’s resignation to a lifetime of disrupted sleep, snoring is not an issue that gets much airplay. Snorers, including the “I-don’t-snore” crowd, may have more than just a problem of annoying those within their noise radius.

Snoring occurs when the muscles and structures lining the throat partially relax closing the airway. It is similar to forcing air through pursed lips. The lips vibrate and a raspberry is born. The rapid airflow through the narrowed airway causes the palate and tongue to vibrate creating the snoring sound or a raspberry in reverse.

Snoring can be a symptom of a serious health risk: obstructive sleep apnea. Obstructive sleep apnea is present in two per cent of women and four per cent of men between 30 and 60 years of age. Obstructive sleep apnea sufferers do not have restorative sleep and one-third have frequent urination during the night. They wake up tired, some with morning headaches, others with little drive or motivation akin to depression.

About ten times per hour, the snorer may stop breathing (apnea) between ten seconds to a minute at a time because the loose structures of the throat collapse blocking the airway.

Breathing restarts with gasping or “snarkling” noises before they resume their snoring rhythm. They may briefly wake up after each apneic spell but have no memory of doing so.

Anatomical changes, lifestyle habits and certain medications negatively affect obstructive sleep apnea:

* Chronic blockage of the nasal passages, a long and wide uvula (the structure that hangs down in the back of your throat), large tonsils and tongue and small lower jaw
* Smoking, lack of sleep, alcohol consumption and sleeping on your back instead of on your side
* Anti-anxiety medications and sleeping pills (valium, alprazolam, lorazepam, oxazepam among others), barbiturates and narcotics

Obesity accounts for 70 per cent of obstructive sleep apnea. Weight gain can increase the incidence of snoring and sleepiness. A large neck size and abdominal obesity are additional risk factors for obstructive sleep apnea.

Excessive daytime sleepiness is a red flag for possible obstructive sleep apnea. This classic sign includes falling asleep while sitting, reading, watching TV, or when at work. Obstructive sleep apnea sufferers tend to be forgetful, more irritable and state that their brain feels foggy. They have a sevenfold increase risk of motor vehicle crashes because of their tendency to fall asleep at the wheel.

They have a greater incidence of work-related accidents, poor job performance, depression, family conflicts and decreased quality of life than those without the sleep disorder. Family members notice these changes and are a great help in bringing this problem to the attention of their family physician.

If you suspect a loved-one or friend may have obstructive sleep apnea, your family doctor will take a detailed sleep history.

Is the snoring loud or quiet? Does it disappear when they lie on their side and return when they roll onto their back? Snoring that sounds like a variable speed buzz saw switching on and off is highly suggestive of obstructive sleep apnea as opposed to quiet steady snoring.

Does the person fall asleep when reading, watching TV, driving a car, sitting in a movie theatre or working at their desk? Are they sleepy, tired or fatigued throughout the day?

Do they stop breathing during the night? Most heavy snorers and patients with obstructive sleep apnea have a dry mouth because they usually breathe through their mouth while asleep.

Your doctor will order a sleep study to confirm the diagnoses. It is the gold standard test for sleep apnea. The sleep lab uses electronic sensors to monitor the sleep cycle brain waves, breathing patterns and oxygen saturation of blood. The latter measurement decreases during apneic spells.

This condition is often neglected, unrecognized and undiagnosed in 80 to 90 per cent of people with obvious signs and symptoms. Studies from the United States report patients visit their family physician about 17 times and a specialist about nine times over an average of seven years before diagnoses of obstructed sleep apnea.

The simple reason for missed diagnosis is that physicians simply do not suspect sleep apnea. Physician awareness of the condition correlates with an eightfold increase in the number of patients diagnosed and treated.

Seven major studies over the past three years link obstructive sleep apnea as an independent risk factor for hypertension, stroke and heart disease. I cannot stress enough how potentially significant this evidence affects patient care.

With treatment, most if not all the signs and symptoms of obstructive sleep apnea resolves within days to weeks.

Why does sleep apnea causes cardiovascular disease? What are the treatment options? Get some sleep and be back here bright and early next week.
© Dr. Barry Dworkin 2003