Sleep Apnea & Snoring

Snoring

Snoring is a loud, hoarse, or harsh breathing sound that occurs during sleep.

Snoring is common in adults and is not necessarily a sign of an underlying disorder.

Sometimes, however, snoring can be a sign of a sleep disorder called sleep apnea. This means you have periods when you are not breathing for more than 10 seconds while you sleep. The episode is followed by a sudden snort or gasp when breathing resumes. Then, snoring starts all over again. If you have sleep apnea, this cycle generally happens several times a night. Sleep apnea is not as common as snoring.

A doctor (or a sleep specialist) can tell if you have sleep apnea by doing a sleep study either at home or in a hospital setting.

Snoring is an important social problem. Persons who share a bed with a someone who snores can develop sleep difficulties.

Causes

In most people, the reason for snoring is not known.

Some potential causes (other than sleep apnea) include:

Being overweight, which leads to excessive neck tissue that puts pressure on the airways.
Last month of pregnancy.
Nasal congestion from colds or allergies, especially if it lasts a long time.
Swelling of the muscular part of the roof of the mouth (soft palate) or uvula, the piece of tissue that hangs down in the back of the mouth.
Swollen adenoids and tonsils that block the airways.
Use of sleeping pills, antihistamines, or alcohol at bedtime.

The following tips can help reduce snoring:

Avoid alcohol and other sedatives at bedtime.
Don't sleep flat on your back. Sleep on your side, if possible. Some doctors even suggest sewing a golf or tennis ball into the back of your night clothes. This causes discomfort if you roll over and helps reminds you to stay on your side.
Eventually, sleeping on your side becomes a habit and you don't need to be reminded.
Lose weight, if you are overweight.
Try over-the-counter, drug-free nasal strips that help widen the nostrils. (These are not intended as treatments for sleep apnea.)

When to Contact Gulf Coast ENT & Allergy

Excessive daytime drowsiness, morning headaches, recent weight gain, awakening in the morning not feeling rested, or change in your level of attention, concentration, or memory.
Episodes of no breathing (apnea) -- your partner may need to tell you if this is happening.
Children with chronic snoring should also be evaluated for apnea. Sleep apnea in children has been linked to growth problems, ADHD, poor school performance, learning difficulties, bedwetting, and high blood pressure. Most children who snore do NOT have apnea, but a sleep study is the only reliable way to tell for sure.

What to Expect at Your Office Visit

Dr. Weiss will ask questions to evaluate your snoring and perform a physical exam, paying careful attention to your throat, mouth, and neck.

Questions may include the following (some of which your partner might have to answer):

Is your snoring loud?
Does it occur no matter what position you are lying in or only in certain positions?
Does your own snoring ever wake you up?
How often do you snore? Every night?
Is your snoring persistent during the night?
Are there episodes when you are not breathing?
Do you have other symptoms like daytime drowsiness, morning headaches, insomnia, or memory loss?

Sleep Apnea

Obstructive sleep apnea is a condition in which a person has episodes of stopped breathing during sleep.

Causes

Normally, the muscles of the upper part of the throat help keep the airway open and allow air to flow into the lungs. Even though these muscles usually relax during sleep, the upper throat remains open enough to let air pass by.

However, some people have a narrower throat area, and, during sleep, relaxation of the muscles causes the passage to completely close. This prevents air from getting into the lungs. Loud snoring and labored breathing occur. During deep sleep, breathing can stop for a short period of time (often more than 10 seconds). This is called apnea.

An apnea episode is followed by a sudden attempt to breathe, and a change to a lighter stage of sleep. The result is fragmented sleep that is not restful, leading to excessive daytime drowsiness.

Older obese men seem to be at higher risk, although as many as 40% of people with obstructive sleep apnea are not obese.

The following factors may also increase your risk for obstructive sleep apnea:

Certain shapes of the palate and jaw
Large tonsils and adenoids in children
Large neck or collar size
Large tongue
Narrow airway
Nasal obstruction
Recent weight gain

Drinking alcohol or using sedatives before sleep may make you more likely to have an episode of apnea.

Symptoms

It is important to emphasize that, often, the person who has obstructive sleep apnea does not remember the episodes of apnea during the night. The main symptoms are usually associated with excessive daytime sleepiness due to poor sleep during the night. Often, family members, especially spouses, witness the periods of no breathing.

A person with obstructive sleep apnea usually snores heavily soon after falling asleep. The snoring continues at a regular pace for a period of time, often becoming louder, but is then interrupted by a long silent period during which there is no breathing. This is followed by a loud snort and gasp, and the snoring returns. This pattern repeats frequently throughout the night.

Symptoms that may be observed include:

Abnormal daytime sleepiness, including falling asleep at inappropriate times
Awakening unrefreshed in the morning
Depression (possibly)
Episodes of no breathing (apnea)
Lethargy
Loud snoring
Memory difficulties
Morning headaches
Personality changes
Poor concentration
Restless sleep

Additional symptoms that may be associated with this disease:

Hyperactive behavior, especially in children
Leg swelling (if severe)

Exams and Tests

Dr. Weiss will perform a physical exam. This will involve carefully checking your mouth, neck, and throat. You will be asked about your medical history. Often, a survey that asks a series of questions about daytime sleepiness, sleep quality, and bedtime habits is given.

A sleep study (polysomnogram) is used to confirm obstructive sleep apnea.

Other tests that may be performed include:

Arterial blood gases
Electrocardiogram (ECG)
Echocardiogram
Thyroid function studies

Treatment

The goal is to keep the airway open so that breathing does not stop during sleep.

The following may relieve symptoms of sleep apnea in some individuals:

Avoiding alcohol or sedatives at bedtime
Dental devices inserted into the mouth at night to keep the jaw forward
Weight management or weight loss

If these measures do not help, your doctor may recommend continuous positive airway pressure (CPAP) therapy. CPAP is the first-line treatment for obstructive sleep apnea.

Surgery may be an option in some cases. This may involve:

Uvulopalatopharyngoplasty (UPPP) to removing excess tissue at the back of the throat
Laser-Assisted Uvulopalatoplasty (LAUP) - A variation on UPPP called laser-assisted uvulopalatoplasty (LAUP) is being increasingly performed to reduce snoring. It removes less tissue at the back of the throat than UPPP and can be done in a doctor's office.
Pillar Implant - The pillar palatal implant is a noninvasive surgical treatment for mild-to-moderate sleep apnea and snoring. However, the main focus of the procedure is a reduction in snoring. The implant helps reduce the vibration and movement of the soft palate.
Tracheostomy to create an opening in the windpipe to bypass the blocked airway if anatomical causes are present (rarely done)

Surgery to remove the tonsills and adenoids may cure the condition in children; it does not seem to help most adults.

When to Contact Gulf Coast ENT & Allergy

Call Gulf Coast ENT & Allergy if you have excessive daytime sleepiness, or if you or your family notice symptoms of obstructive sleep apnea.

If you have this condition, call if symptoms do not improve with treatment or if new symptoms develop.

Decreased consciousness, extreme sleepiness, hallucinations, personality changes, and persistent confusion can be a sign of a medical emergency. Seek immediate medical attention or call your local emergency number, such as 911.

Prevention

Children with very large tonsils and adenoids may develop sleep apnea and related problems. They should be evaluated by a health care provider to determine whether they need to have their tonsils or adenoids removed.