Snoring: Nuisance or Disease?

Julian Whitaker, MD

Snorers get no respect. They’re the target of jokes as well as the jibes of spouses who, according to a Mayo Clinic study, lose an average of one hour of sleep nightly.

But that’s the least of their problems. Snorers are more than seven times more likely to be involved in a motor vehicle accident than non-snorers and are also more prone to work-related mishaps. They are more likely to suffer with headaches, irritability, concentration lapses and fatigue. Perhaps most important, people who snore may be at increased risk for serious health concerns such as hypertension, heart disease, diabetes, and obesity.

The root of all these problems is not snoring itself, which is caused by noisy vibration of the soft palate and tongue—that’s more of an annoyance than a major health hazard. However, snoring is also the most evident symptom of a very serious and often-overlooked condition known as sleep apnea.

Sleep Apnea Deprives You of Oxygen…

Obstructive sleep apnea (also called sleep-disordered breathing) is a mechanical problem that interferes with breathing. During deep relaxation the uvula (the bit of tissue hanging down in the back of the throat that nobody seems to know the name or purpose of) and the soft palate collapse on the airway, causing a partial blockage. Then the tongue, drawn backwards by the negative pressure of the lungs as they expand, forms a tight seal that prevents any air at all from entering the lungs. Breathing literally stops.

As a result, the amount of oxygen carried in the blood drops dramatically. To compensate the heart pumps out more blood with each contraction and beats faster and faster. At the same time rising carbon dioxide levels in the blood rise send messages to the brain to breath, and this kicks in a flood of hormones in an effort to arouse the sleeper just enough to take a breath.

A diagnosis of sleep apnea is made when five such events, each lasting at least 10 seconds, are observed per hour. Severe cases may involve as many as 30 breathing pauses an hour, some lasting more than a minute! A less severe form of this disorder called hypopnea involves only partially closed airways, but also results in strained breathing and inadequate oxygen intake.

…And Robs You of Rejuvenating Sleep

In addition to oxygen deprivation, sleep apnea robs its sufferers of the two most rejuvenating stages of sleep. During the deepest and most restorative stage of sleep, slow-wave sleep, the brain dramatically winds down and the muscles relax. As this gives way to REM (rapid eye movement) sleep, the state in which we dream, relaxation deepens to the point of paralysis to prevent potentially dangerous acting out of dreams. It is during these two stages of sleep, when the tongue and soft palate are at their most relaxed, that apnea occurs and sleep is interrupted.

It is easy to see how interference with these vital stages of sleep may result in daytime sleepiness, irritability, and cognitive problems. But there’s more. Sleep apnea also dramatically increases the risk of hypertension, heart disease, stroke, and diabetes.

Sleep Apnea Triggers Serious Disease

The link between sleep apnea and hypertension is the strongest. The increase in cardiac output and heart rate during episodes of sleep apnea raises blood pressure temporarily. Recent research confirms that the condition also causes periodic episodes of elevated blood pressure during the day and often leads to chronic hypertension.

The Wisconsin Sleep Cohort Study followed 709 patients for four years, periodically monitoring their degree of apnea and their blood pressure. Researchers found that moderate sleep apnea doubled risk of hypertension and severe apnea tripled risk.

Dozens of studies have reached similar conclusions, including one carried out at the University of California and the Veterans Affairs Medical Center in Los Angeles. In this study, men with sleep apnea were six times more likely to have obstructions of the carotid arteries (a risk factor for stroke) than age-matched controls. And the men who had both sleep apnea and carotid blockages had double the risk of diabetes as those without the blockages.

How to Put a Lid on Snoring

Sleep apnea can sometimes be treated with lifestyle measures, and the most effective of these is weight loss. Obesity is a well-known risk factor for sleep apnea, and it often leads to poor sleep even in the absence of apnea. Even moderate weight loss can improve sleep and reduce the number of apnea events.

Intriguing research suggests that there may in fact be a circular relationship between obesity and sleep apnea. Numerous studies have shown that when animals and humans are deprived of REM sleep, they tend to overeat. Dr. Jennifer Peszka of the University of Southern Mississippi at Hattiesburg confirmed this in 163 patients with sleep apnea. The heaviest patients were those who got the least REM sleep, and treated patients whose REM sleep improved the most had the greatest weight loss. In other words, not only is weight loss an effective treatment for sleep apnea, but if sleep apnea is effectively treated, it may be easier to control appetite and lose weight.

Other lifestyle changes that may help include quitting smoking and avoiding alcohol before bedtime, as both are associated with snoring and sleep apnea. Simply changing sleeping position works for some. Sleeping on your side rather than your back discourages the soft tissues of the airways from collapsing. One way to “remind” yourself to turn onto your side is to sew a tennis ball onto the back of your pajamas. Custom-designed cervical pillows that extend and lift the neck may also help.

Treatments for More Serious Cases

The current gold standard in the treatment of sleep apnea is continuous positive airway pressure (CPAP). This requires wearing a nasal mask or seal attached to a blower that forces pressurized air through the nose and prevents the throat from collapsing. CPAP is very effective in reducing sleep apnea. The downside to the device is that some patients are unable to tolerate it, due to feelings of claustrophobia, nasal or facial irritation, and other side effects.

Another option is a device worn in the mouth that keeps the airway open. There are two primary types of appliances, which are usually made by dentists or ENT physicians. One holds the jaw slightly forward to increase the dimension of the airway, while the other prevents the tongue from relaxing back into the airway. They work well for many patients.

Sometimes surgery is required to remove blockages in the airway. Tonsillectomy and adenoidectomy are sometimes helpful, particularly in children. In adults, procedures to increase the size of the airway by removing the uvula and part of the soft palate may be recommended. This can be done by traditional surgery, laser, electrocautery, or, the newest and least invasive entry into the field, radiofrequency energy (somnoplasty). While these procedures may improve symptoms, all have risks, and some patients require more than one procedure to attain optimal benefits.

Recommendations

• Sleep apnea is a common condition, and its incidence increases with age. Although snoring is the most common symptom, it is not a prerequisite. If any of the following pertain to you, I urge you to get tested for sleep apnea: frequent and loud snoring, pauses in your breathing while sleeping, fatigue upon awakening and sleepiness during the day, high blood pressure, or obesity. If you are diagnosed with sleep apnea, seek treatment at once.
• According to some experts, even simple, noisy snoring is not a good thing—it means you’re working too hard just to take in air. Implement the lifestyle measures discussed above for putting a lid on snoring. Anything you can do to improve your sleep will provide enormous health benefits.
• To receive treatment for sleep apnea at the Whitaker Wellness Institute, contact a Patient Service Representative at (866) 944-8253 or click here.

References

• Christensen, D. Is snoring a dizzease? Science News. 2000, Mar 11;157:172-3.
• Friedlander, A et al. The prevalence of carotid atheromas seen on panoramic radiographs of patients with obstructive sleep apnea and their relation to risk factors for atherosclerosis. J Oral Maxillofac Surg. 1999 May;57:516-22; discussion 521-2.
• Peppard, PE et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378-84.
• Obesity linked to sleep disorders. Reuters Health Information. Jun 22, 1998.

Modified from Health & Healing with permission from Healthy Directions, LLC. Copyright 2000. Photocopying, reproduction, or quotation strictly prohibited without written permission from the publisher. To subscribe to Health & Healing, click here.