Snoring & Sleep Apnea

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Overview

According to the American Academy of Sleep Medicine, an estimated 10 percent to 30 percent of adults snore. For most, snoring has no serious medical consequences. However, for an estimated five in 100 people, extremely loud nightly snoring is the first indication of obstructive sleep apnea syndrome (OSAS) – a potentially life-threatening disorder. OSAS is characterized by a pattern of obstructive breathing during sleep, awakenings from sleep and daytime symptoms.

In normal children and adults, sleep is accompanied by relaxation of the muscles that stiffen and open the throat. This muscular relaxation leads to a slight sleep-related narrowing of the throat that is of no importance for most people. However, in those suffering with OSAS, the sleep-related narrowing is so great that breathing becomes difficult, and the experience can be likened to breathing through a floppy, wet straw. The brain senses that breathing is difficult and increases the effort to breathe, briefly awakening the brain in order to stiffen and open the throat. Once awake, with a fully open throat, effort to breathe decreases. As breathing effort returns to normal, sleep is resumed and the cycle repeats itself. This detrimental cycle can disturb sleep dozens to hundreds of times each night, but most of the awakenings are so brief that they are not remembered.

Risks and Side Effects

Sufferers of OSAS may not get enough oxygen during sleep and probably don't sleep soundly. They may suffer daytime sleepiness affecting work and social activities, and increasing the likelihood of car accidents. OSAS sufferers may also be at risk for high blood pressure, heart failure, heart attack or stroke.

Symptoms

In adults:

• Loud snoring
• A pattern of snoring interrupted by pauses, then gasps
• Trouble concentrating, forgetfulness, irritability, depression and loss of interest in sex
• Headaches or nausea upon awakening
• Frequent nighttime urination or bed-wetting

In children:

• Snoring or “squeaking” during sleep
• Appear to have difficulty breathing during sleep
• Fitful sleep
• Daytime hyperactivity in younger children and sluggishness in older children

An otolaryngology evaluation is very helpful in the evaluation of snoring and OSAS. A careful examination of the upper airway is performed both to try to determine the site of airway collapse as well as to make sure that there are no other medical problems that might be causing the sleep disturbance. Possible sites of obstructions include the nose, tonsils, soft palate and uvula, tongue and voice box. Treatments will differ depending on the severity of the problem and the results of the exam.

Treatment

Options for snoring include the following:

• Weight loss
• Avoidance of alcohol and certain medications that may worsen snoring
• Obtaining adequate sleep, so that an individual is not overly sleepy, which can worsen snoring
• Specially made earplugs for the bed partner
• Dental mouthpieces
• Nasal surgeries
• Minor outpatient procedures done in the clinic to stiffen the soft palate and to decrease its flutter and noise. These procedures include injection snoreplasty, PillarTM implants, radio frequency treatment to the soft palate (Somnus) and laser-assisted uvulopalato-pharyngoplasty (LAUP). At Lahey Clinic, we perform all of these procedures, and your consultation would include a discussion of which would be best for you.

Options for obstructive sleep apnea include the following:

• Weight loss
• Avoidance of alcohol and certain medications that may worsen sleep apnea
• Continuous positive airway pressures (CPAP): An appliance forces air through the nose and acts as a stent to keep the airway open at night. This is a very successful treatment for obstructive sleep apnea and is usually tried before other therapies. However, some patients do not tolerate the mask and seek other options.
• Dental mouthpieces (usually for mild sleep apnea problems)
• Surgery – This may include operations on the nose, soft palate and uvula, tongue and neck. These operations are directed at the possible sites of obstruction in the hopes of doing the minimal surgery necessary to correct the sleep problem. These varieties of surgeries, as well as specific recommendations, would be discussed with you at the time of consultation.

CPAP Clinic

As part of our Sleep Disorders Center, we have a CPAP Clinic for our patients being treated for sleep apnea with CPAP. In this clinic, run by our chief sleep technologist, Ann Wilkinson, R.PSG.T., we see patients who are having difficulty adjusting to CPAP, as well as our patients with equipment problems. This Clinic has been very helpful in increasing compliance with CPAP therapy.

For more information:
American Academy of Sleep Medicine
One Westbrook Corporate Center, Ste.920
Westchester, IL 60154
Tel: 708-492-0930
www.aasmnet.org

American Sleep Apnea Association
1522 K Street, NW, Ste. 302
Washington, DC 20005
asaa@sleepapnea.org