Snoring

SNORING, SLEEPINESS AND SLEEP APNOEA

Snoring is an annoying habit. Any snorer's partner, friends or family will tell you! Usually the person who snores is totally unaware of the problem. However, we now know that snoring can be a clue that the person is having difficulty breathing during sleep. This can lead to long-term health problems.
During sleep, especially during dream sleep (or REM sleep), the muscles of the body become limp and floppy. In most cases, this helps the body to become relaxed. This will help us to sleep. However, among the muscles that become floppy during sleep are the muscles that normally keep the throat, or upper airway, open for breathing. When these muscles become floppy, the throat can partly collapse in on itself. The airway can then become narrowed. Thankfully, in most people, this is not harmful, and they can breathe normally.
In some people, the throat narrows more than usual during sleep. This can cause serious narrowing of the air passage. Breathing can then be affected. If the narrowing is not too bad, this causes snoring. Snoring is a noise made by the vibration of air passing through the narrowed airway. If the narrowing is more severe, the throat can close altogether. This causes an apnoea, which means "no breath". The affected person actually stops breathing. The apnoea usually lasts only a few seconds. This is because the person's brain senses that breathing has stopped. The brain will then wake the person briefly from sleep. This brief awakening is enough to open the throat passage. The person starts breathing again and then returns quickly to sleep. In people with sleep apnoea, the cycle of throat narrowing followed by apnoea followed by wakening can be repeated dozens, or even hundreds, of times a night. The number of cycles depends on how severe the sleep apnoea is. This may lead to disturbed sleep. The sufferer may feel tired and sleepy the next day.

WHY DOES THE THROAT NARROW IN PEOPLE WITH SNORING AND SLEEP APNOEA?

Anything that causes the throat passage to narrow more than normal during sleep can lead to snoring and/or sleep apnoea. The most common cause is being overweight. This is especially if the person's neck is short and/or thick. The extra fat in the neck can squeeze and narrow the throat passage during sleep. Other things that can narrow the throat include large tonsils, large adenoids, a large tongue, a backwardset jawbone or a small chin. If the nose is blocked, this can also lead to throat narrowing. The blocked nose causes a low pressure in the throat. This results in the walls of the throat being sucked together. Alcohol and sedatives close to bedtime can worsen snoring and sleep apnoea. Alcohol tends to cause the muscles holding the throat open to become more floppy than usual.

WHAT TYPE OF PERSON DEVELOPS SNORING AND SLEEP APNOEA?

Sleep apnoea is much more common than was previously thought. It is the second most common treatable respiratory illness after asthma. The typical person who gets sleep apnoea is an overweight middleaged man with a large neck. Sleep apnoea can affect younger people. Even children, and women can be affected, especially if they are overweight. Thin people can sometimes be affected. Such individuals may have enlarged tonsils or some other abnormality. In some people, we simply do not know why they get sleep apnoea.

SYMPTOMS OF SLEEP APNOEA

People with sleep apnoea usually snore loudly. It is often the person's bed partner, or family, who notice the problem first. Often, the bed partner will report that they have seen the person stop breathing for a few seconds during sleep (an apnoea). These are things that the affected person often doesn't notice.
The main symptom noticed by the person with sleep apnoea is extreme daytime tiredness and fatigue. The person can fall asleep almost anywhere. This can result in poor performance in school, or at work. In some cases, it can lead to losing one's job. Most seriously, the sufferer can fall asleep while driving; this can result in road traffic accidents.
Other symptoms may include morning headaches, feeling unrefreshed after sleep, nighttime choking episodes, nightmares, loss of sex drive, irritability and depression.
The combination of snoring and daytime sleepiness makes the diagnosis of sleep apnoea likely. Many people with sleep apnoea may develop high blood pressure. This sometimes improves with treatment of the sleep apnoea. It may, however, need blood pressure medication.

HOW DO WE CONFIRM THAT A PERSON HAS SLEEP APNOEA?

The diagnosis of sleep apnoea may be strongly suspected from the person's symptoms. To confirm the diagnosis, tests are carried out in hospital. This is done while the person is asleep. A good "screening" test is to measure the level of oxygen in the blood during sleep. This is done with a small plastic probe placed on the index finger. People with severe sleep apnoea often drop their oxygen levels during sleep. The finger probe can detect this. Often, this is enough to confirm the diagnosis.
If there is any doubt about the diagnosis, then a sleep study, or polysomnogram, will be needed. This involves coming into the hospital to have your breathing and sleep pattern monitored while you sleep. Soft bands are placed around the chest and abdomen to measure breathing. Small probes are placed on the head. These are to measure sleep quality. Oxygen levels can be measured with a small plastic probe placed on the index finger. All of this is entirely painless. A noise monitor in the room can detect snoring. Sometimes the person can be recorded on a video monitor. This allows the doctor to see the sleep disturbances.

SNORING AND SLEEP APNOEA CAN BE TREATED!

To improve sleep apnoea, measures include losing weight and avoiding alcohol and sedatives close to bedtime. Keeping the nose clear and avoiding sleeping on the back are other measures. A tennis ball sewn into the back of one's pyjamas can help to do this. Removal of tonsils may improve or get rid of the sleep apnoea if the tonsils are very large. A simple dental device, worn like a gumshield, can often help to reduce snoring. Very rarely, an operation to remove tissue at the back of the throat can help to stop severe snoring and sleep apnoea. The only effective treatment available at present for bad sleep apnoea is continuous positive airway pressure (CPAP). This involves nightly use of a device called a CPAP machine. This machine sucks air from the bedroom. It blows the air, under pressure down the nose, through a small mask that is worn over the nose. The machine is small and light. It can be placed on the bedside locker. The nose-mask is connected to the machine by light plastic tubing. The air blown through the nose in this way acts as a "splint". It keeps the throat open for the whole sleep period. It gets rid of snoring and the apnoeas. The CPAP machine must be used every night to be effective. It needs to be worn for the whole sleep period if possible. Although a bit uncomfortable at first, the vast majority of people get used to it. The results of CPAP treatment can be dramatic for the patient and their family. Snoring is eliminated, sleep is greatly improved and daytime sleepiness disappears.