Anit T. Patel: What you should know about snoring and sleep apnea

Sleep is a window to our health. Good sleep contributes to our health, safety and overall well-being. Getting a good night’s sleep impacts every aspect of our lives – at home, at work, in community life and even behind the wheel of a car. 

According to the National Institutes of Health, at least 70 million people in the U.S. have sleep problems for a few weeks every year, while 40 million suffer for longer periods of time. Because of sleep problems, millions of people do not get enough sleep to function at their best during their waking hours. Even more have poor-quality sleep that may be disrupted or associated with other medical or health problems that keep them from getting sufficient deep or restorative sleep. 

As many as one-half of all United States males and one-quarter of U.S. females snore to varying degrees. Snoring is the sound of partially obstructed breathing during sleep. It occurs when the structures in the throat are large and when the muscles relax enough to cause the airway to narrow and partially obstruct the flow of air.

As air tries to pass through these obstructions, the throat structures vibrate, causing the sound we know as snoring. Large tonsils, a long soft palate and uvula, deviated nasal septum, and excess fat deposits (especially in obese patients) contribute to soft tissue narrowing, causing the loud snoring. While snoring can be harmless, it can also be the sign of a more serious medical condition known as obstructive sleep apnea.

People with obstructive sleep apnea experience a complete obstruction of airflow through the airway. This generally occurs because of muscles and excess tissue in the airway that cave in during inspiration.

It’s like sucking air through a soggy straw: When you breathe in, the airway narrows and causes complete obstruction. During the pauses in breathing, the oxygen level in your blood drops. Your brain reacts to the drop in oxygen by waking you enough to resume breathing (and snoring), but not necessarily enough to fully waken you.

The cycle of snoring, not breathing, waking and resuming breathing means that you do not get good-quality sleep. Most times, people with apnea don’t even realize they’re waking up and falling asleep all through the night. But the process leaves them exhausted, and they often feel very sleepy during the day, wake up with headaches and find it hard to concentrate, and their daytime performance may suffer. 

The effects of sleep apnea range from annoying to life-threatening. They include depression, high blood pressure, irritability, sexual dysfunction, learning and memory problems, and falling asleep while at work, on the phone or driving. People with severe sleep apnea are two to three times more likely to have automobile crashes. Risks for heart attacks, high blood pressure, heart failure and stroke are also increased with sleep apnea. 

People who have symptoms of sleep apnea should have a sleep study (polysomnogram). The study consists of different measures of sleep that may include snoring; breathing; oxygen levels; heart rates; body, muscle and eye movements; and a recording of brain waves to determine stages of sleep and other brain activity. Among other things, the study will allow your sleep medicine specialist to differentiate between simple snoring and obstructive sleep apnea. 

In mild cases, behavioral changes may be enough to stop the sleep apnea. These include weight loss, learning to sleep on one’s side instead of the back, and avoiding alcohol, sleeping pills and smoking. 

For more significant sleep apnea, the standard treatment is a Continuous Positive Airway Pressure machine. The CPAP mask is worn by the patient at night to direct air flow through the nose to open the airway and allow unobstructed breathing to occur. 

For those patients who cannot tolerate the CPAP mask, surgery may be indicated. This may involve removal of obstructing tissues such as the tonsils, adenoids, uvula, soft palate, base of tongue, and/or correction of a deviated septum. In severe cases, the entire jawbone must be advanced to open up the airway. 

The future is very bright for treatment of obstructive sleep apnea as continued improvements are made in CPAP therapy as well as surgical advances to improve outcomes. However, the main issue at this point is increasing awareness of this disorder in the community. The vast majority of the estimated 18 million people who have obstructive sleep apnea are currently undiagnosed.

Anit T. Patel, M.D., MBA, is an ear, nose and throat physician who attended Tufts University School of Medicine and did his undergraduate training at Johns Hopkins University. He is a clinical assistant professor at Tufts Medical Center. His office is located at Plymouth Ears, Nose, & Throat, 30 Aldrin Road, Plymouth, MA. To schedule an appointment, call 508-746-8977.