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When snoring is something serious

Created date

February 26th, 2013

Judy didn t think it was any big deal when her husband Carl started snoring. Men in their 70s snore that s a fact of life, she figured. Besides, a gentle nudge usually quieted him enough so she could go back to sleep. True, they both felt tired during the day, but isn t that just a normal side effect of aging? Daytime fatigue in an otherwise healthy person is not natural, no matter how old you are, says Leslie Rigali, D.O., medical director at Brooksby Village, an Erickson Living community in Peabody, Mass. According to the National Heart, Lung, and Blood Institute, the leading cause of daytime sleepiness is sleep apnea.

Sleep apnea basics

The most common type is obstructive sleep apnea (OSA). During sleep, your airway collapses and blocks airflow. As a result, your breathing may be shallow or even stop altogether for a few seconds or minutes up to hundreds of times overnight. Your blood oxygen level plunges, and your body responds by arousing you just enough to start breathing again. Sleep apnea typically causes quite a racket snoring as the air squeezes past the blocked area and a loud snort, gasp, or choking sound when breathing resumes. This fragmented sleep pattern results in daytime drowsiness, which is not something to be taken lightly. You are at risk for accidents such as falls, Rigali says. It interferes with your thinking processes and affects how well you perform even simple tasks. OSA is also associated with a number of serious medical conditions. People with sleep apnea are at risk for developing high blood pressure, heart disease, and diabetes, says Stacey L. Ishman, M.D., M.P.H., director of the Johns Hopkins Center for Snoring and Sleep Surgery in Baltimore, Md. We don t know for sure if there s any causative link, but we do know that OSA and these conditions often coexist.

Do you have OSA?

Sleep apnea is more common in males and your risk rises as you get older. As we age, our muscles get weaker, including the muscles involved with breathing, says Kathy C. Richards, Ph.D., assistant dean of the doctoral division and research development at George Mason University s College of Health and Human Services in Fairfax, Va. But the biggest risk for OSA by far is obesity. Being overweight can put a strain on the respiratory system and interfere with the mechanics of breathing, Richards explains. Fat deposits may accumulate in the neck and throat. Not everyone who snores has sleep apnea. And not everyone who has sleep apnea snores. There s no blood test for it, but your doctor can evaluate your risk, ask you some questions, refer you to a sleep medicine specialist, and recommend a sleep study if necessary. The only way to truly diagnose OSA is to have an overnight sleep study, Ishman says. This study, called polysomnography, measures your sleep pattern, airflow, body position, oxygen levels, and many other factors. Most often it is conducted in a specialized sleep lab, but home systems are becoming increasingly available.

Today s treatments

Treatment for OSA will be based on your sleep study results. Sometimes, lifestyle changes may be needed. Losing extra pounds is the number one treatment for OSA, Ishman says. Whether you do it on your own or on a medically supervised program, taking off a little weight can greatly lessen the burden on your nighttime breathing. Increasing your physical activity and avoiding alcohol or sedatives may also help. Some people with mild forms of OSA may need a specialized oral device that repositions the jaw, but others with moderate or severe OSA need continuous positive airway pressure, or CPAP, Richards says. CPAP systems operate by gently blowing air into your throat through a mask. For people who can t tolerate CPAP, a bilevel system (BiPAP) is an option the airflow changes based on when you inhale and exhale, Richards explains. CPAP and BiPAP have changed a lot in recent years, Rigali says. They are more comfortable, less noisy, and there are many types of machines and masks available. If you re unhappy with one kind, try another. Your doctor can change the settings, adjust the fit of the mask, and help to make it more comfortable, Ishman says. It may take several weeks to get used to it, but it s well worth the time investment when you see how much better you feel. A fairly new treatment that works essentially the same way as CPAP is called Provent. This is a disposable patch that fits over the nostrils, Richards explains. It creates pressure in the airway when you exhale. It s been shown to be effective for some people, but it needs more testing to evaluate its effectiveness long term. Another downside: Provent is expensive, and although FDA-approved, the device is not yet covered by Medicare. Upper airway corrective surgery for OSA is not a common practice for adults, mainly because it hasn t been shown to be as effective as CPAP as a first-line therapy but may be considered as a second-tier option if CPAP is not tolerated. And, if someone has a specific anatomic abnormality, surgery may be a good option, Ishman says. There may be more and better treatment options down the road. Researchers are studying whether sleep apnea in seniors should be treated differently than in younger adults, Richards says. There s a lot we still don t know about it.