Is it Sleep Apnea? Or just Snoring?

Posted on Wednesday, January 5, 2011
By Scott Akin, MD

How many of us snore? How many of us are awakened by others who sound like they're sawing logs? Certainly many adults, and even some children.

In addition to causing poor sleep and daytime drowsiness, snoring is sometimes the sign of a serious disorder called obstructive sleep apnea (OSA).

Normally when we sleep, air moves through the airways and into the lungs in a regular, rhythmic fashion. When we sleep, the muscles that control speaking, swallowing and breathing relax.

In a normal person, this does not result in any problems. However, in a person with OSA, the muscle relaxation temporarily blocks airflow for 10 to 60 seconds or longer. Carbon dioxide builds up as a result until the person wakes up- reopening the airway.

People with OSA may be sleepy during the day, and may have heart problems including high blood pressure, abnormal heart rhythms, strokes and heart attacks, at times leading to an early death.

"But doc, everyone snores...this sleep apnea thing isn't that common, is it?" Yes, it is common. While not everyone who snores has obstructive sleep apnea, about 25% of adults are at high risk for getting it, and certain factors make it more likely.

What causes OSA?

Like many diseases, some of it is genetic, from our parents. That is, some of us are born with smaller airways or a large tongue. Other risk factors include:

Obesity
A Large neck (generally larger than 17 inches around in men or 16 inches in women)
Male (twice as common as in females)
Current tobacco smokers
Nasal congestion
Older age
Sedation from alcohol or medications that cause drowsiness

Some symptoms that should prompt you to see your health care provider include:

Loud snoring (often noted by a partner)
Awakening with gasps for air, or a choking sensation
Restless sleep
Low energy or fatigue during the day despite a "normal" amount of sleep (usually 8 hours)
Unintentionally falling asleep during the day
Feeling groggy and tired in the morning
Difficulty concentrating or memory problems

If your health care provider is suspicious that you may have OSA, testing is either performed at a "sleep laboratory" (where sleep cycles are monitored - including body movements, breathing patterns, heart rate and oxygen levels), or at home with a simple bedside device.

How is OSA treated?

There are several ways to manage OSA. Most commonly, patients are fitted with a mechanical device called a continuous positive airway pressure machine (CPAP), which blows air into the mouth or nose through a mask which helps keep the airways open.

Other treatments include using a special dental device, and, in rare cases, surgery.

There are also steps you can take to deal with OSA:

Lose weight. Additional fat around the neck narrows the airway.
Use a nasal spray or nasal strips at night.
Cut back on alcohol and sleeping pills.
Avoid sleeping on your back or use special pillows designed to help position your neck.

Many patients who get their OSA treated show dramatic improvement, feel better, and reduce their risk for complications. It is especially important to diagnose OSA prior to having surgery.