Is Your Snoring More Than Just a Nuisance?
By: David A Fein, MD
Sleep. We spend nearly a third of our lives doing it. No animal can do without it and some spend more than half their lives doing it. Yet we really understand very little about why we have to do it and what happens when it goes wrong. But when it does go wrong, the consequences for our health and the quality of our daily life can be devastating.
There are more than 70 recognized sleep disorders. One of the most common is Sleep Apnea, a condition estimated to be as common as diabetes. Yet the condition often goes undiagnosed because of lack of awareness by both the public and medical professionals. There is no simple in-office test for Sleep Apnea and blood tests are not helpful either. The vast majority of Sleep Apnea sufferers remain untreated and at risk for serious consequences.
“Apnea” is the medical term for not breathing. Most, but not all, people with Sleep Apnea are loud snorers. But unlike those who are merely annoying to their bedmates, people with Sleep Apnea stop breathing, sometimes for 30 seconds or more, during sleep. This may happen as often as 5 to 30 times an hour. Each episode is like a near-drowning. The oxygen level in your blood begins to fall, your heart rate increases and your blood pressure rises. When your breathing finally does start again it is often accompanied by a loud snore or choking sound. Aside from the stress it creates for your body, each episode is also likely to disrupt the normal patterns of your sleep.
Sleep is typically classified into 5 stages, ranging from light to deep. We generally dream in the deepest stages of sleep. Normal sleep requires moving up and down through these stages in a specific pattern. When you stop breathing during sleep you start to wake up. Instead of spending a substantial part of the night in deep stage sleep, those with Sleep Apnea are repeatedly pulled out of deep stage sleep and spend most of the night having very fragmented periods of light sleep. Despite nearly suffocating several times and hour, sleep apnea sufferers often don’t fully awaken. Most people with Sleep Apnea are not even aware that their sleep is being disturbed. They may say that they sleep 8 hours straight through the night. With all the disruption to their sleep patterns, those 8 hours don’t provide truly “restorative sleep” and they end up feeling like they got much less sleep.
Sleep apnea is a common “silent killer”. The symptoms usually develop very gradually, often over a period of years. Very few patients suspect they have Sleep Apnea. But, once they are treated, the difference is startling. Within just a day or two of getting a normal night’s sleep, Sleep Apnea suffers often report feeling 10 years younger and can’t imagine how they did not notice how poorly they were feeling.
Memory and concentration problems are common in people with Sleep Apnea. Imagine being able to sleep only an hour or two each night. It would not take many nights before you found your brain feeling too foggy to work. Since Sleep Apnea prevents you from getting normal sleep, no matter how much time you spend in bed, the effect is the same.
Studies have also found a strong link between poor sleep and weight gain. While being over-weight increases your risk of Sleep Apnea, having a sleep problem seems to also make it much more likely that you will gain more weight. Until the Sleep Apnea is found and treated, losing weight is likely to be very difficulty.
The mortality rate is higher in patients with mild to moderate sleep apnea
High blood pressure is seen 50-70% of patients with sleep apnea. Several large studies have demonstrated that Sleep Apnea is a risk factor for developing hypertension, independent of obesity, age, alcohol intake, and smoking. Those with significant Sleep Apnea were more than twice as likely to have hypertension, independent of other variables.
Sleep Apnea also increases your risk of metabolic syndrome. The metabolic syndrome is now recognized as an important contributor to the development of atherosclerosis and cardiovascular disease. A patient with the metabolic syndrome has increased fasting glucose levels, increased blood pressure, lipid abnormalities, and obesity. Multiple studies have shown that patients with Sleep Apnea have increased glucose levels and increased insulin resistance. In a recent study from the Sleep Heart Health Study, among 2000 research subjects with Sleep Apnea the prevalence of diabetes rose to 15%.
The incidence of stroke and heart attacks are also known to be higher in patients with Sleep Apnea. Irregular heart beats and congestive heart failure occur more frequently in Sleep Apnea. Your odds of a work-related accident and driving accidents are also markedly increased.
Symptoms generally begin insidiously and are often present for years before diagnosis. They include:
- Snoring, usually loud, habitual, and bothersome to others
- Witnessed apneas, which often interrupt the snoring and end with a snort
- Gasping and choking sensations that arouse the patient from sleep
- Restless sleep, with patients often experiencing frequent arousals and tossing or turning during the night
- Not feeling refreshed upon awakening
- Morning headache, dry or sore throat
- Daytime fatigue that usually begins during quiet activities (eg, reading, watching television): As the severity worsens, you begin to feel sleepy during activities that generally require alertness (eg, school, work, driving). Most patients who do not complain of excessive daytime sleepiness will complain of being fatigued, having a lack of energy, or being tired during the day.
- Personality changes, problems with memory or concentration
If you have even just one of these symptoms, being tested for Sleep Apnea may be advisable. Screening for Sleep Apnea has recently become much easier. Simple devices can be used at home that monitor oxygen level, heart rate, blood pressure even detect snoring and stage of sleep. The measurements are made with a non-invasive monitor that slips over one fingertip. A small computer is worn on the wrist which records the data throughout the night. If evidence is seen that suggests Sleep Apnea, more formal evaluation can be done at a Sleep Laboratory and treatment can be started. Many of those who suspect they have Sleep Apnea have hesitated to get tested because they are worried that the treatment is unpleasant. Fortunately, great improvements have been made in this area as well. Treating Sleep Apnea today is usually comfortable and very effective.