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The Snoring Sickness: Do You Have Sleep Apnea?


Rochelle Zak, M.D, Daniel Wagner, M.D


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We all know that snoring can be a real annoyance for a sleeping partner. But in some cases, snoring is an indication of a more serious problem than partner frustration. Sleep apnea is a condition characterized by the cessation of breathing during sleep, and often goes unrecognized by those who suffer from it.

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Below, two sleep disorder experts offer an introduction to sleep apnea, its diagnosis, and treatment options.

What is sleep apnea?
DANIEL WAGNER, MD: "Apnea" means "without breath." And sleep apnea is a type of "without breath" that occurs only during sleep. The majority of cases are obstructive, where the throat -- back behind your tongue -- literally gets sucked closed by the chest as it's trying to pull air through it. That's because the muscles of the throat have relaxed enough when you're asleep to allow that to happen. It would never happen while you were awake -- you would choke and know it immediately.

That goes on for 10, 20, 30, sometimes 60 seconds. The efforts of the chest finally wake the person up briefly, usually without their knowing it. They breathe a few times and get their oxygen levels back up, and then as they fall back into light sleep, the whole business happens again.

Is snoring sometimes unrelated to sleep apnea?
DANIEL WAGNER, MD: About half of men at age 50 snore chronically or habitually at least part of every night, and about 5% to maybe 8% of men at age 50 have sleep apnea.

What causes sleep apnea?
SHELLEY ZAK, MD: This is very often a weight-related phenomenon. If you put on some weight and find suddenly that you are snoring at night-- that's a key indicator of apnea. Sleep apnea is both related to weight and to your anatomy.

What are the health issues associated with the condition?
SHELLEY ZAK, MD: There are very good data that show an association of sleep apnea with high blood pressure, heart attacks and probably stroke. It is an important medical problem.

People can live with sleep apnea for a long time and not worry about it. They feel a little sleepy and they're not refreshed in the morning. The potential for a car accident or anyone who operates heavy machinery, is quite high.

How is sleep apnea diagnosed?
SHELLEY ZAK, MD: The only way to diagnose it is to look at the sleep and breathing in an individual at a sleep center, where they will make a polysomnogram for diagnosis.

What can you do for the condition, besides keeping slim and trim?
SHELLEY ZAK, MD: The long-term cure is usually weight loss. But you can't lose weight if you're exhausted, you're not sleeping, and you have no energy.

The short-term treatment is called nasal CPAP -- continuous positive airway pressure. It's a machine about the size of a loaf of bread and it literally blows pressurized air into the back of the throat. What this does is work as a pneumatic splint. You may ask, "How can anyone sleep like that?" But the reality is, if someone has significant sleep apnea, they sleep wonderfully with the CPAP machine.

There are also a couple of medications that will sometimes reduce snoring and mild sleep apnea. These are some of the old anti-depressants that actually work pretty nicely.

Are there surgical treatment options for sleep apnea?
DANIEL WAGNER, MD: Yes. What's most commonly done is to trim the soft palate and some of the side parts of that membrane. That procedure was introduced about 20 years ago and works pretty well for snoring but not so well for the more severe cases of sleep apnea, a point that surgeons tend to underemphasize.

There are major surgeries on the throat and the jaw that can cure sleep apnea and there are also dental appliances that can help people with mild to moderate sleep apnea. They pull the jaw forward, which pulls the tongue forward, making more room in the throat and less resistance to the flow of air and less flapping of that little uvula and the soft palate. You can discuss this option with a knowledgeable dentist.