Snoring and Sleep Apnea

Snoring is the sound produced by air when it passes through relaxed tissues of throat. Vibrations of the tissues as we breathe cause the sound. Snoring is a common problem and almost everyone would have suffered at least once. But when it becomes chronic or causes sleep apnea, it has to be treated. The good news is that snoring and sleep apnea can be successfully treated. Solutions to snoring are behavioral, medical and surgical. Read on to find out what causes snoring, what are the risk factors and how to treat it.

Complaints

The main complaint of a snorer is the loud and disturbing sound. It’s more bothersome to the partner than the individual who snores. Simple snoring, where the only complaint is the sound, is not very serious. But snoring can be a part of a bigger problem called Obstructive Sleep Apnea. In that case you need to get a professional consult.

In addition to the sound, my patients often complain the following as well-

1. Day time sleepiness

   

2. Throat dryness
3. Mood swings
4. Inability to concentrate
5. Difficult relationships
6. Restless sleep
7. Elevated blood pressure
8. Throat pain upon waking up in the morning
9. Falling asleep while driving or watching TV
10. Poor performance in college or school or workplace
11. Disturbance of partner’s sleep

When you have any of the problems listed above, you should get a consult from us. Because it may be pointing to sleep apnea syndrome.

Obstructive Sleep Apnea Syndrome – OSAS

When snoring occurs, there is vibration of lax tissues of throat which come in the way of breathing. First of all, the obstruction reduces oxygen supply to lungs and bloodstream. Next, when the blood passes into the brain, reduced oxygen decreases the performance. Thereafter, brain releases certain chemicals to increase your heart beat so that more blood is pumped to make good the loss of oxygen. Heart rate increases causing raised blood pressure.

Whenever there is an obstruction, lungs work harder to get the same amount of air into the bloodstream. There is a strong sucking effect on air while breathing in. As a result the relaxed tissues get sucked in causing more obstruction. When the obstruction is complete, there is a pause in breathing. The oxygen tension reduces further and suddenly the brain wakes you up. You gasp for air and wake up transiently.

In obstructive sleep apnea, the above cycle continues for 30 to 40 times every night. You will be surprised that the maximum time when you are not breathing can be as high as 60 seconds even. During every such cycle there is decreased oxygen supply to brain and other organs. Pumping of blood by heart and blood pressure increase significantly. This syndrome causes heart attacks, heart chamber enlargements, hypertension, diabetes, weight gain, aging, hair loss and many more.

Causes

We see that most patients of snoring and sleep apnea have one or more of the below problems.

1. Anatomical issues in mouth – Thick and bulky tongue, Thick soft palate, Long uvula, Reduced mouth opening
2. Neck issues – Thick neck, Short neck
3. Nasal problems – Deviated septum, Nasal polyps, Sinusitis
4. Laryngeal problems – Web in the voice box, Growth in voice box, Reflux problems, Curved epiglottis
5. Neuromuscular disorders – Some people have lack of coordination between muscles due to faulty nerves

Risk Factors

Many conditions are associated with sleep apnea and snoring problem. Some directly increase the severity whereas others contribute to the causes. First of all, people who are obese or overweight frequently encounter the problem. The main solution in them is to reduce weight and maintain a healthy BMI. Secondly, alcohol relaxes the muscles and tissues in your throat and worsens snoring. Smoking causes throat dryness and nasal congestion, thereby aggravating the problem. Thirdly, being a man increases your lifetime risk of developing OSAS. Some other risk factors are lying down flat on bed, having a family history of snoring and nasal deviations.

What may happen if you let it be?

OSAS is not a simple problem and needs evaluation. Those who do not take treatment for it, may have serious consequences. Many suffer from lack of concentration and day time sleepiness. As a result a few have had spoilt inter-personal relationships and motor vehicle accidents. Most importantly, elevated blood pressure and decreased oxygenation can cause stroke and lifetime paralysis. Some have suffered massive heart attacks as well. The causes, risk factors, snoring and its complications together form a vicious cycle. Do not ignore snoring and end up with adverse cardiac events. Seek help. Are you suffering from snoring silently? Does you partners sleep apnea and snoring bother you? Do you suffer from any of the complications of the disease? If so, talk to us.

Snoring Solutions – Tests done

When you go to an ENT clinic the doctor will examine you to check for the cause. He may ask for

1. X-ray to check for any bony obstruction
2. Nasal endoscopy – to rule out rhinitis, deviation, adenoids
3. CT scan of nose – to rule out sinusitis or polyps
4. Laryngoscopy – to check for the back of tongue, tonsils, epiglottis
5. MRI Neck – to check for soft tissues in neck, tongue and palate
6. Sleep study – to grade the disease and find out parameters affecting the heart and brain

Sleep study or Polysomnography is the most important test. We place a set of probes on various sites of your body and they connect to a device measuring oxygen saturation, breathing, pulse, blood pressure, oxygen in brain, brain electrical activity and ECG. After an overnight sleep the device gives a report on the various parameters. We do the sleep study at hospital or your bedroom.

Snoring Solutions – Treatment

There are various ways of managing this condition. Talk to us to find out what is best for you. The treatment part is divided into lifestyle and dietary modifications, medical management and surgical.

Some home remedies you can easily do form the essence of lifestyle and dietary modifications. You need to exercise and maintain an optimum weight for your height. You must make sure your BMI is within the healthy range. Dietary modifications include avoiding carbs and watching your calories. We will discuss home remedies for snoring in a separate article detailing every aspect.

In certain cases of morbid obesity, the patient may be referred to a bariatric surgeon for weight loss. Maintenance of optimum weight for height and exercising regularly reduce snoring. We advice our patients to continue these even after we prescribe CPAP or choose surgery.

CPAP

CPAP, which stands for continuous positive airway pressure, successfully abolishes snoring in a lot of people. You will have to fix a mask over your face and air in positive pressure will be delivered through it. This keeps the tissues turgid and prevents vibration. However, many people complain about the discomfort due to masks. The positive pressure makes their throat go dry.

Sleep Surgery

Snoring or sleep surgery is a highly specialized branch of ENT surgery. It will not be successful unless its accompanied by weight loss, dietary and lifestyle modifications. The sleep surgeon assesses the level of obstruction in your upper airway and tailors the surgery as per your anatomy. The surgery frequently involves the removal of tonsils, trimming of the palate and uvula and reduction of the girth of the tongue. We shall explain everything about snoring surgery in a different post.