More Than a Snore

Get Wise to Symptoms of Sleep Apnea

People often joke about their friend or relative who snores like a jackhammer. But snoring noisily can be an indicator of sleep apnea, a condition which left untreated, is no laughing matter.
According to the National Sleep Foundation, around 90 million American adults snore at night, with 37 million snoring on a regular basis. “Primary snoring” involves the vibration of relaxed throat tissues, but sleep apnea is a more serious disorder that repeatedly halts breathing for several seconds at a time, lowering blood oxygen levels during sleep. In an effort to re-stimulate breathing, your brain awakens you quickly, then lets you drift off again. While you may not remember these unconscious interruptions, they can prevent you from getting adequate rest despite even a full-night’s sleep.
There are three types of sleep apnea:
Obstructive: The most common type of sleep apnea, this type causes the throat muscles to intermittently relax, blocking the airway during sleep.
Central: Central sleep apnea occurs when the brain won’t send adequate breathing signals to your muscles.
Complex: Those with complex sleep apnea have symptoms of both obstructive and central sleep apnea.
Understanding Your Risk
Carrying extra weight is the number one risk factor for sleep apnea because fat deposits can block the airways. “People who are obese have a four times higher risk of sleep apnea,” explains Marcile Leaf, a certified family nurse practitioner with In Good Health and rounding nurse practitioner at the Bridge at Ooltewah.
Ironically, sleep apnea can contribute to obesity by interfering with the body’s appetite-regulating hormones –  leptin, ghrelin, and cortisol – which are produced during sleep. Without adequate sleep to produce these hormones, you may eat more than you need and your metabolism takes a nose dive.
Age is another important risk factor for sleep apnea. Why? “Because as we age, the muscles in the back of the throat become more lax, which can contribute to blocked airways,” says Leaf.
However, although sleep apnea is most common among people who are overweight and over the age of 40, those who are younger and at a healthy weight can suffer from the condition too. Having a larger neck, other family members with sleep apnea, nasal blockage from allergies, sinus issues, a deviated septum, and smoking may also increase your risk.
Becoming a Sleep Sleuth
Symptoms of sleep apnea may include loud snoring, episodes of breathing cessation, difficulty staying asleep, excessive daytime sleepiness, attention problems, irritability, and headaches. While snoring noisily can indicate sleep apnea in men, women typically do not snore as frequently because their throat and palette structures are different.
Dr. F. Chung and his associates at Toronto Western Hospital in Toronto, Canada have created an easy assessment called “STOP-BANG” to summarize major sleep apnea symptoms. Having between five to eight of the following indicates a high likelihood for developing sleep apnea, with three to four indicating an intermediate likelihood.
Snore: A loud snore can be a
warning.
Tired: Repeated arousals sabotage your sleep.
Observed: Has your partner or roommate observed you choke, gasp, or stop breathing during your sleep?
Pressure: Between three and four out of 10 adults with high blood pressure have sleep apnea.
BMI: People having a body mass index of 30 or more have a higher risk.
Age: It most commonly affects adults over 40. Sleep apnea can become more serious with age.
Neck: Men’s necks measuring more than 17 inches and women’s measuring more than 15 inches can constrict the windpipe.
Gender: Men are twice as likely to get sleep apnea than women.
Treatment and Diagnosis
If you suspect you may be suffering from sleep apnea, don’t wait to make an appointment with a health care provider. Patients who consult with a physician at the onset of symptoms – and go into the initial appointment prepared – typically have the best outcomes. “Keep a sleep diary that includes your symptoms, potential life stressors, or recent changes,” says Leaf. “Bring it with you to the appointment along with a list of all medications, vitamins, and supplements, and consider asking your significant other to come along.”
If your symptoms warrant further evaluation, your health care provider may suggest a sleep center study. In a study, patients sleep overnight in a hotel-like atmosphere with sensors on the head, chest, and finger to measure brain waves, blood oxygen levels, heartbeat, and breathing patterns.
Another option for diagnosing sleep apnea is using an Apnea Risk Evaluation System (ARES) machine at home and returning it to your doctor for results analysis.
Once the extent of your sleep apnea has been determined, you can explore treatment options. Treatments range from the more conservative lifestyle changes to the more invasive surgical procedures. The various options include:
Lifestyle Changes
Losing weight can improve cholesterol levels and minimize fat blocking the airway.
Machines 
Continuous Positive Air Pressure (CPAP) machines blow a continuous air stream through a mask to keep your airway unobstructed during sleep. Certain CPAPs now minimize congestion by using warm, moist air. “If you can get over the initial discomfort of having something in your face, you can begin to sleep well and wake up refreshed. Once you start noticing improvements, you put up with it,” says Paul Bates, a physician assistant with Erlanger Sleep Medicine and Neurology.
He continues: “Over the years, these machines have become smaller and quieter. Some machines will even send you messages
in the morning about the breathing disturbances you had, the machine’s effectiveness, and more.”
Patients may also benefit from recent advancements in technology. “New machine technologies, such auto-adjusting PAP devices (AUTOpaps), can monitor breath and adjust pressures throughout the night,” says Bates.
Mouthpieces
Wearing a custom-made mouthpiece called a Thornton Adjustable Positioner (TAP) to reposition your jaw and tongue can also help keep your airway clear. According to Bates, mouthpieces are ideal for mild cases of sleep apnea and snoring. “For the right person, it’s a good option,” he says. “It requires the patient to sleep with something in their mouth that pulls the lower jaw forward and opens the back of the throat.”
Surgery
As a final resort, surgery can tighten, minimize, or remove extra mouth and throat tissue, reposition the jaw, or help patients lose weight to alleviate sleep apnea. However, surgery may not prevent the condition from reoccurring in the future, and it’s not a guaranteed fix. “Evaluation is needed after a surgery, because sometimes it works and sometimes it doesn’t,” Bates says.
Want to Learn More?
Don’t wait to take action. Two of the best places to find more information about sleep apnea, its symptoms, and diagnosis are the American Sleep Apnea Association at sleepapnea.org and the American Academy of Sleep Medicine at sleepeducation.com.
Beyond Rest Disrupted sleep and snoring aren’t the only issues associated with sleep apnea. It can also contribute to several health issues including:
• perpetual sleepiness
• irritability, depression
• heart failure
• stroke
• high blood pressure
• car and heavy machinery accidents