Snoring and sleep apnea are two conditions that are widely prevalent in North America. What is the connection between them?
Snoring simply refers to noisy breathing during sleep. The noise is caused by turbulent airflow through the upper airway, and usually reflects a partial obstruction to the passage of inhaled air. The obstruction may be fixed and unmoving, such as a deviated nasal septum, or actually vibrating, such as the soft palate. The intensity of snoring may be so loud that one of the sufferers (and there are usually two: the snorer and the listener) has to leave the bedroom. On occasion, the noise actually wakes up the snorer himself, interrupting important sleep.
Sleep apnea, which may accompany snoring, refers to episodes when the person actually stops breathing, often from complete obstruction of the airway. He may struggle or gasp for air, partially awakening as the oxygen level drops, before resuming his noisy breathing. Partial obstruction, called hypopnea, is also harmful.
Although snoring and sleep apnea often coexist, there is a difference. While snoring is a nuisance, sleep apnea is a serious medical condition that may lead to high blood pressure and heart disease.
How can you tell if you snore? Usually someone will gladly volunteer to inform you. If not, you may indirectly diagnose yourself. If you experience nasal obstruction, wake up with a dry or sore throat, or a hoarse voice, chances are that you are breathing (inefficiently and noisily) through your mouth. A tape recorder can confirm your suspicion. If you also wake up tired, headachy, feel fatigued during the day, are irritable and moody, lack concentration, and have the tendency to unpredictably drop off to sleep during the day, then sleep apnea is likely your diagnosis.
Certain factors predispose to both snoring and sleep apnea. These include obesity, consumption of alcohol or sleeping pills, and sleep deprivation. Obstruction of the upper airway may be due to nasal blockage, a short neck, receding chin or large tonsils. However, not every person with sleep apnea fits this stereotype: some are slim and appear to be in the pink of health.
If you suspect you may have either or both of these conditions, the first step is a physical examination. This is often followed by a sleep study, during which your heart rate, oxygen levels, brain waves and breathing effort are measured. If you do have apnea, it needs to be treated in order to preserve your long-term cardiac health.
The initial treatment for both snoring and sleep apnea is, in many cases, to lose any excess weight. Avoiding alcohol and sedatives and sleeping on the side with the head of the bed elevated are all useful ancillary measures. Some patients do well with externally applied nasal dilator strips, which are available at most drug stores.
If these fail, there are several specific treatment options available, and you may need to resort to more than one for a definitive cure. If the airway tends to collapse on inhalation, the use of positive air pressure can be very useful. This treatment, called CPAP (Continuous Positive Air Pressure), involves wearing a mask at night that, even during exhalation, keeps the walls of the pharynx apart. Unfortunately the machine is cumbersome, somewhat uncomfortable, and a real wet blanket to your sex life. Nonetheless, for some patients CPAP is a potentially life saving measure.
If a specific cause for the obstruction can be identified, such as a deviated nasal septum, surgery may be a useful treatment option. Nasal surgery or removal of enlarged tonsils may be a useful treatment for snoring, if not always for sleep apnea.
Surgical shortening of the soft palate presents a potential dilemma for singers. This surgery, which may be done using different instruments (including the laser or the radiofrequency probe), does cause some scarring of the palate, which may be an issue for the vocal performer (as well as wind instrument players). I am much more hesitant in recommending this to singers than to non-vocalists.
When dealing with snoring or sleep apnea, making the diagnosis is most important. Treatment needs to be tailored to the specific problem of each patient, keeping in mind his or her professional needs.
DISCLAIMER: The suggestions given by Dr. Jahn in these columns are for general information only, and not to be construed as specific medical advice, or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician.
