Obstructive Sleep Apnea
Obstructive Sleep Apnea is a health hazard that can be alleviated in a variety of ways. Read these tips to help determine which treatment is right for you.
Snoring can come from all shapes and sizes. For instance, have you ever seen Jurassic Park?
There’s a famous scene where the Tyrannosaurus Rex, a towering prehistoric leviathan, unwittingly gives away its presence to the main characters when its lumbering footsteps send small shock waves through a glass of water in their vehicle. It’s an incredible piece of cinematography, conveying the monolithic scale of the monster by insinuation as opposed to just showing the scaly-skinned pursuer.
Now let’s take my sleeping mother, put that same glass a hundred yards away, and watch as her snores not only vibrate the water but shatter the glass. Her snores are something of a legend.
I come from a family of earth-shaking snorers, so snore-centric sleep health is near and dear to me. I think it’s important we take a thorough look at what snoring is, and why it might be a sign of certain body systems going off the rails.
Snoring is funny. I think it’s funny. Well, I used to.
We’ve been conditioned to think in such a way. Between cartoons, film, and comic strips, we find a loud and exaggerated snore comedic. However, off of the screen (or page), snoring can be an indicator of damaging lifestyle factors or life-threatening health problems like sleep apnea.
With 40% of men and 24% women snoring habitually, this is a widespread issue not to be taken lightly. Many who snore fail to realize these sounds can be a signal from the body screaming that something is wrong, or worse – a symptom of several potentially life-threatening disorders.
A snore is an involuntary hoarse snorting sound due to obstructed air movement while breathing during sleep. It is caused by vibration of the muscles and soft tissues in the back of the throat, the soft palate (roof of the mouth) and/or the uvula.
When these tissues are enlarged or relax too much and touch each other, the airway through the throat is obstructed and, as air tries to pass through, the soft tissues vibrate and this produces the snoring sound.
An estimated 45% of people snore at least occasionally, and 25% snore regularly. It is about twice as common in men as in women, and tends to increase with age.
Common or “conventional” snoring (i.e. not related to a sleep-disordered breathing problem like sleep apnea or upper airway resistance syndrome) may be annoying, but it is not in itself dangerous to the health. Chronic snoring, however, may lead to severe sleep problems and other possible complications, or it may be a symptom of other sleep disorders, such as sleep apnea, which may require direct treatment.
Conventional snoring is most common in the deepest part of non-REM sleep (stage 3), followed by lighter non-REM sleep (stage 2), and it tends not to occur at all during REM sleep, when breathing is usually at its shallowest. However, snoring resulting from sleep apnea mainly occurs during REM sleep, when the loss of muscle tone is most likely to compromise respiratory systems and cause apneas.
The noise level of snoring is typically around 60 dB (a similar level to loud talking), but it can rise to 80-90 dB (as loud as a pneumatic drill or a lawnmower) or, in extreme and rare cases, to over 110 dB (almost as loud as an airplane talking off). Any noise over around 85 dB for an extended period of time is considered potentially harmful.
Severe snoring can disturb the snorer’s own sleep (as well as that of their sleeping partner), even if it is not part of another disorder such as sleep apnea. It has also been associated with an increased risk of heart attack and stroke, decreased libido, marital problems, etc.
There are many risk factors that increase the probability and severity of snoring. They most often are:
Fat deposits on the neck, chin, and chest can all help close off the airway and put pressure on the base of the tongue, making the passageway to your lungs that more much constricted.
Alcohol is a central nervous system depressant, which means it relaxes the muscles in your body – tongue and throat included. When throat and tongue muscles around the airway are relaxed, the tissues have less structure and support and so restrict the flow of air.
Similar to alcohol, many common medications cause CNS depression and relaxation of the muscles. Benzodiazepines, painkillers, and muscle relaxants all leave important muscular structures loosened while allergy medications that tend to dry mucosal membranes in our breathing passages have been shown to increase the prevalence of snoring as well.
We’re not talking about post-coital snoozing here. Men, statistically, are more prone than women to snoring. Unlike the above risk factors, this one is a smidge more difficult to remedy.
Cigarettes are known to cause inflammation of the airways, restricting breathing. The science on linking cannabis and e-cig use to snoring is murkier, but at least in the case of marijuana use research has suggested it can act in a way similar to muscle relaxants.
Things like congestion, growths in the nose, misaligned bones after a break, and deviated septums can all contribute to impeded or altered air flow through upper airways.
Some people just have bad luck. You could have a naturally thinner trachea or a longer and more hindering soft palate. Might just be a case of the cards you were dealt.
I don’t want to go the WebMD route and convince you it means you’ll die of incurable brain cancer in a few weeks, but snoring can be a sign of some serious sleep disorders – namely sleep apnea.
At its most mild and intermittent, snoring may cause some fragmented sleep and irritation of the soft tissues along your airway. Not great, not terrible. Many people that snore suffer no devastating adverse effects and have no underlying disease or disorder, just possessing one or more of the risk factors above. Quitting smoking and losing weight might do it for them.
There are, however, a portion of serial snorers out there for whom the nightly roars serve as a sign of something much more serious than the fact that you might have a chubby neck.
Sleep apnea is a disorder characterized by momentary lapses in breathing occurring during sleep. Individuals with the disorder often find themselves waking up struggling for air after an episode of hypoxia, the body reacting violently to being starved of oxygen.
These respiratory pauses can either be mechanical (physical blockage of the airway due to extraordinary muscle relaxation or swelling) or chemical (a lack of signals from the brain telling the body to breathe) and occur anywhere between five to 100 times an hour.
The two are referred to as Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA) respectively, with the former the most common manifestation of the disorder. The combination of the two is known as Complex Sleep Apnea Syndrome or Treatment-Emergent Central Sleep Apnea.
The disorder is disconcertingly common. 3-7% of adult men and 2-5% of adult women have OSA severe enough to bring about daytime sleepiness. The true prevalence is like much higher, with the medical community believing sleep apnea is heavily under-reported.
In most cases, snoring is a precursor of sleep apnea. No snoring? Most likely you do not have sleep apnea.
Some peoples’ intensity of snoring may be very loud, but are not actually causing any harm or danger to their bodies at all (except when their partners punch them during the night).
As long the individual is breathing, and their lungs have constant access to sufficient amount of oxygen during the night, they are usually okay. We will eventually talk about how we know if there’s a lack of oxygen while sleeping.
As we explained before, snoring comes from a slight obstruction in the airway, sometimes, people snore too much and eventually their airways are fully obstructed. An “apnea” or sometimes spelt “apnoea” (depending on where you are in the world), by definition means one episode of “stop breathing”.
When a person stops breathing continuously for 10 seconds, this is counted as one “apnea”, the amount of times you have apnea episodes per hour determines how severe your level of sleep apnea is, we will discuss more on these later.
Whether it’s a buildup of fluid in the neck or a genetic disorder like Polycystic Ovarian Syndrome, sleep apnea poses grave health risks to afflicted individuals – even though the symptoms don’t always seem obvious.
Loud and frequent snoring is the most common symptom in sleep apnea cases, but it’s not necessarily there 100% of the time. Nearly all sleep apnea patients snore, but few who snore have sleep apnea. Snoring without being affected by the disorder is known as “primary snoring.”
The second most visible symptom in cases of sleep apnea is waking during the night out of breath or gasping. This should be a pretty strong signal you need to speak with your doctor.
Other symptoms include fatigue and sleepiness, dry mouth upon waking, brain fog, sexual dysfunction, and poor sleep quality.
Not sure if you’re at risk for sleep apnea? You can start by taking this 1-2 minute sleep apnea questionnaire. Note: this is purely for informational purposes. Only a licensed doctor can provide a true medical diagnosis, but this can help you understand if you display some of the symptoms of sleep apnea.
But wait, it gets worse.
Undiagnosed or untreated sleep apnea can result in a laundry list of potentially life-threatening conditions including but not limited to:
The mechanisms that connect sleep apnea with the above disorders are many and complex and should be spoken with a trained medical professional.
Well, maybe not. Emergent research has suggested a relationship between the so-called “primary snoring” discussed previously and a thickening of the arterial walls in the carotid arteries.
These two arteries fork from the aorta and are responsible for delivering blood to the head and brain. Obviously, the restriction of blood to the brain is a very serious issue, and this sort of impediment in delivering oxygen to the brain has a strong relationship with increased risk of a stroke.
It’s important to note that in this study, subjects were chosen specifically that snored habitually but did not have sleep apnea. Despite being just primary snorers, these individuals showed much higher rates of carotid thickening than did non-snorers. Additionally, this type of carotid thickening was not present in others at risk for cardiovascular disease like smokers or those with high cholesterol.
While the link here might seem equal parts convincing and terrifying, the research has been met with conflicting studies that show no evidence of carotid dysfunction amongst primary snorers. The suggestion, perhaps, is that snoring is a symptom of other dysfunctions or detrimental lifestyle factors that would also contribute to cardiovascular disease – as opposed to the root cause.
It gets complicated here. Sleep apnea is more an umbrella term for disorders that cause repeated and complete obstruction of airways during sleep than a specific disorder with one single cause. Tonsils, tongues, and tracheal issues (among many others) could all be the culprit of your breathing obstruction.
Related: How to stop snoring
Continuous Positive Airway Pressure (CPAP) machines are the most oft-prescribed solution for sufferers of sleep apnea. The machine pumps a pressurized stream of air into a mask secured onto sleeping users, forcing their airways to stay open during the night.
While there are other treatments available, some for the symptoms and some to fix the underlying disorder responsible for your sleep apnea, we’ll leave that to the doctors to discuss.
It’s important to remember that most snoring is probably fairly inconsequential. Even if you’re a loud snorer, the chances of having a stroke or going into cardiac arrest during your sleep are minimal.
However, habitual snorers should probably see their primary care doctor if for no other reason than to give them peace of mind. As always, sleep disorders are never improved by stress and sleep loss, so it’s important to get to the root of the issue as opposed to letting it stew.
For more on earth-shattering snores the dangers of having a double chin, stay tuned on Mattress Advisor.