People who snore loudly have been fair game for cartoonists and comedians for decades. Loud, disruptive snoring—the kind that wakes other members of your household and sometimes even the neighbors—is nothing to laugh at. It may be a potentially life-threatening condition such as sleep apnea.

Apnea is a Greek word that means "want of breath." Loud snoring is a distinctive sound created when air tries to force its way through the narrow passageway of soft tissues in the throat or upper airway it is not fully opened during sleep. For most of the estimated 10 percent to 30 percent of the adults who snore, snoring has no serious medical consequences. Extremely loud and habitual snoring, however, can be an early indicator of sleep apnea for an estimated five in 100 people.

People with sleep apnea may breathe fine while awake but they don’t breathe properly during sleep. Studies show that those with severe sleep apnea may not breathe properly for up to 75 percent of the time they spend in bed. It is characteristic for a person with sleep apnea to exhibit a pattern of snoring with intermittent pauses that are followed by a gasp or loud snort. The sleeping individual experiences periods of breathing difficulty then resumes breathing with a loud snore.

This interruption of the sleep cycle interferes with the flow of oxygen to the body. Left untreated, sleep apnea can lead to:

• Excessive daytime sleepiness
• High blood pressure
• Heart failure
• Heart attack
• Stroke

People who snore very loudly, in all body positions, should see their physician to investigate the causes. A consultation with a sleep disorder specialist may be recommended to discuss signs, symptoms, testing procedures, and treatments available. Fortunately, sleep specialists can detect breathing disorders in their earlier, more treatable stages.

Warning Signs of Sleep Apnea

Sleep specialists have recorded snoring levels as loud as jet planes and jackhammers. Snoring this loudly translates into frequent awakenings or arousals from sleep. This can lead to severe daytime fatigue affecting the snorer’s ability to work, drive or conduct routine daily activities. People with sleep apnea also have a two to five times higher incidence of having a car accident than those who don’t have this disorder.

Other warning signs exhibited by people with sleep apnea may include:

• difficulty concentrating
• memory problems
• anxiety
• emotional problems
• moodiness
• falling asleep at inappropriate times
• depression

These problems can occur suddenly or develop over time. The startling thing is that sufferers are usually unaware of these symptoms. Some family members have even gone so far as to tape record or video record an individual in an attempt to prompt him to seek evaluation and treatment. They become so accustomed to living with the symptoms that they think it is normal. Family members, friends and coworkers are often the first to recognize the signs and encourage the sufferer to seek help.

• People with sleep apnea may notice or complain of:
• multiple awakenings through the night
• thrashing in bed
• waking up gasping
• waking up with dry mouth in the morning
• morning headaches
• lack of interest in sex

They may also lack enthusiasm for activities that they once enjoyed. Men may also complain of difficulty maintaining a state of sexual arousal.

In children, sleep apnea has been linked to some cases of Sudden Infant Death Syndrome (SIDS). The exact relationship is still uncertain. Sleep apnea can be present in children who are overweight or who have enlarged tonsils. Children suffering from sleep apnea may snore, exhibit stridor (squeaking-type of noise), have difficulty breathing and sleep very fitfully or restlessly. It is not normal for a child to snore and parents should report their child’s snoring and habits to a health care provider or pediatrician. Older children with sleep apnea may seem overly lazy, slow and exhibit poor performance in school.

Causes of Sleep Apnea

During normal sleep, the muscles—including those used in breathing and supporting the upper airway—relax more than they do during awake periods. In some people, the throat muscles relax too much causing the breathing passage to become partially or totally blocked. This interferes with breathing throughout the night. Sleep becomes an increased time of risk.

In others, these muscles relax normally during sleep, but the breathing passageway is narrower than normal and causes partial or total blockage to breathing. In less common cases, the brain "forgets" to send a signal to the muscles the control breathing.

Types of Sleep Apnea

Obstructive sleep apnea is the most common and severe type of sleep apnea. The muscles of the soft palate relax and sag, and when these muscles relax too much or block a narrowed airway, breathing can become struggled or noisy. When these airway walls collapse, breathing is completely blocked. When breathing periodically stops, a listener hears snoring broken by pauses. These pauses are apnea events. As the urge to breathe increases, the breathing muscles of the chest and diaphragm work harder to overcome the blockage in the airway. Sleep is then temporarily interrupted, the brain briefly shifts from a sleep to an awake state, and the throat muscles increase in tone and the blockage is relieved. Awakenings are usually so brief and incomplete that the sleeper does not remember them in the morning. Someone with obstructive sleep apnea may stop breathing for 10 seconds or longer and may experience hundreds of apnea events each night.

Each time breathing stops, the level of oxygen in the bloodstream drops and the heart must worker harder to circulate blood. Blood pressure rises and may stay elevated after breathing restarts. The heart can also sometimes beat irregularly and may even pause for several seconds. These irregularities of the heart may account for some of the deaths during sleep of people who went to bed in apparent good health. Alcohol, sleeping pills, and sedatives taken at bedtime further reduce the muscle tone of the upper airway and make it more easily susceptible to collapse.

One or more of the following conditions may contribute to sleep apnea:

• smaller than normal jaw
• enlarged tonsils
• tissues that partially block the entrance to the airway

Obstructive sleep apnea most often strikes overweight men. Female hormones and a slightly different upper airway anatomy may protect women until later in life. As both sexes grow older, the age gap narrows but never entirely disappears.

Central Sleep Apnea

In this type of sleep apnea, the airway may remain open, but the breathing muscles of the chest and diaphragm stop working. Decreasing levels of oxygen signal the brain to awaken the sleeper and restart breathing. Central sleep apnea becomes more common with age. About one in four persons over the age of 60 experiences disturbed breathing during sleep. Usually the problem is mild. It becomes more significant and severe in people with congestive heart failure or neurological disorders. People with central sleep apnea may be more aware of their frequent awakening during the night compared to those with sleep apnea.

Going to See Your Doctor

Your physician or sleep specialist will gather a detailed medical history from you and may want to talk with your bed partner or other members of your household to gain further information. A physician who suspects sleep apnea will refer the patient to a sleep disorders center or sleep physician for further evaluation and testing.

The patient may need to spend one or two nights in a sleep diagnostics laboratory while being monitored by sleep specialists using highly specialized equipment. A sleep study will identify if sleep apnea or other sleep disorders are present and identify the best approach for treatment.

Before arriving for a sleep study, such as those conducted through Gaylord Sleep Services, the patient is instructed to avoid caffeine, alcohol, smoking and naps. At Gaylord Sleep Services, the patient watches a brief instructional video that describes how the testing is performed. Small, thin wires are placed on the patient’s head, legs, and chest to monitor the muscle activity, brain waves and the heart. A finger probe is placed on the finger to monitor oxygen levels throughout the night. A thin wire is placed on the upper lip and two bands are wrapped around the chest and abdomen to monitor breathing. Once the patient is made comfortable in a private room, he or she is monitored until morning. It takes approximately two weeks for the referring physician to receive the final results of the interpreted information obtained during an entire night’s study.

Treatment Options

You can improve the quality of your sleep—whether you have sleep apnea or not—by following these options:

Lose weight
If you are over your ideal weight, drop 10 percent of your body weight to improve breathing during sleep, sleep more restfully and reduce daytime fatigue.

Avoid alcohol two hours before bedtime
Alcohol depresses breathing and can make apneas more severe and more frequent. Alcohol may also induce apnea in people who would otherwise only normally snore.

Avoid sleeping pills
Sleeping pills depress breathing and generally make sleep apnea worse. Exceptions may be made for people troubled by frequent awakenings unrelated to breathing problems and should only be taken under a physician’s advice.

Take all drugs with care
Medications prescribed for headaches, anxiety, depression, and other common problems can affect sleep or breathing.

Sleep on one side
Some people suffer sleep apnea or snoring only while on their back. Use pillows behind your back or try other devices designed to keep you on your side.

Nasal decongestants
Medications to relieve congestion of the nose may be helpful in reducing snoring and the likelihood of apnea.

Oral appliances
Devices that open the airway by bringing the jaw, tongue, and soft palate forward help some patients. These fit into your mouth much like a boxer’s or football player’s mouthpiece.

Surgery
There are several physical abnormalities that interfere with breathing during sleep and can sometimes be corrected surgically. These include: enlarged tonsils or adenoids, nasal polyps, deviated septum, and malformations of the jaw or soft palate.

Uvulopalatopharyngoplasty (UPPP or UP3)
This is a surgical technique that removes the excess tissue at the back of the throat that may block the airway during sleep. Studies show that this procedure benefits about half of those who have it done. This surgery seems to help those individuals with a mild to moderate form of sleep apnea and is more beneficial to those suffering from chronic snoring alone. Some patients have reported side effects such as nasal speech quality and regurgitation of fluids when swallowing if too much tissue is removed.

Oxygen
Oxygen is rarely used as a treatment for sleep apnea but may be indicated in patients who have a co-existing lung disease.

Medication
As of yet, there is no one medication that can be used to significantly treat sleep apnea. Certain medications may help mild cases of obstructive sleep apnea and some cases of central apnea.

Continuous Positive Airway Pressure (CPAP)
CPAP consists of a small mask worn over the nose. It delivers filtered air under a small, constant pressure and has been highly effective in treating most patients with sleep apnea. Air pressure lends support to the airway that would normally collapse in a patient with obstructive sleep apnea and allows them to breathe normally. The benefits include improved sleep quality, restored oxygen levels, less stress on the heart, elimination of snoring, and improved energy levels during the day. This device runs quietly through the night but needs to be worn on a nightly basis. While not for everybody, it does remain the most effective and inclusive form of treatment.

For more information on sleep and sleep disorders, check out the National Sleep Foundation's Web Site at www.sleepfoundation.org