Just a Snore, or Something More?

Anthony Burgess, the novelist and composer, has been quoted as saying, “Laugh and the world laughs with you. Snore and you sleep alone…”

Despite clever sayings like that and nearly endless jokes about snoring spouses, snoring is literally no laughing matter.

Snoring is that often annoying sound made by vibrations in the back of the throat or nose in someone who is probably deeply asleep. It is more common in men, in people who are overweight, or in those over the age of 50. But anyone can snore, including skinny young women and even babies and children.

Snoring may be transient, such as when the nose is stuffed up because of a cold or seasonal allergies. In this case it may be a little irritating to someone trying to sleep in the same room and the snorer may not be sleeping well.

But that all passes as soon as they recover from their temporary condition. Generally, there is no harm done.

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Chronic snoring, though — the kind that occurs every night and sometimes throughout the night — is often a sign of something much more sinister than the common cold. When the tissues at the back of the throat become so relaxed and loose during sleep that they vibrate loudly and incessantly, they are also blocking the free passage of air in and out of the lungs. Sometimes the tissues collapse completely or the tongue falls back against them and the breathing stops altogether. It can stay that way for a minute, even more.

When this happens, the blood oxygen level falls and the brain begins to panic – it is suffocating!

The brain has to make a choice between breathing and sleeping and luckily, sleeping usually wins. The brain wakes up, the person may gasp, gurgle or choke, but they are quickly back asleep again and the snoring cycle begins anew.

This can happen dozens, even hundreds of times during the night and the sleeper often has no recollection of any of it in the morning. All he or she knows is they are tired even after a full night of “sleep.” This is obstructive sleep apnea or OSA.

It makes sense that those with OSA may be fatigued during the day. That repeated life and death struggle to breathe through the night is not restful and the resulting daytime sleepiness can be dangerous.

In fact, a study presented to the Association of Professional Sleep Societies in June of 2015 revealed that people with sleep apnea are twice as likely to be involved in a workplace accident and 2.5 times more likely to be the driver in an automobile crash than those who do not have the sleep related breathing disorder.

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According to the National Sleep Foundation, OSA affects 1 in every 15 people, representing a significant and growing public health concern. Those with sleep apnea are more susceptible to depression, obesity, diabetes, heart disease, high blood pressure and have been shown to be more likely to die from cancer than those without sleep apnea.

To determine if someone has temporary snoring from another condition or has potentially perilous obstructive sleep apnea, an overnight sleep study may be done. This can be done in a sleep laboratory or with equipment that is sent to the home to be worn for a night or two. The sensors record breathing, oxygen levels, movement during sleep and, in the more advanced studies, also brain waves to determine the exact stages of sleep.

The data is compiled by a computer and analyzed by a medical practitioner who specializes in sleep medicine. This information can verify if sleep apnea is present, whether it is the obstructive type or less common central type. It can also establish how serious the disorder may be and suggest appropriate treatment options.

Treatment for OSA can range from simple adjustments in sleeping positions to combinations of invasive surgeries to remodel the airway to assure clear breathing. The most common treatments used in the U.S. today are the CPAP machine and the mandibular advancement device. A CPAP, which stands for continuous positive airway pressure, is a computerized blower that supplies gentle air pressure via a tube and face mask to hold the relaxed throat tissues open while the patient sleeps.

Though some find it obtrusive, many people have discovered the breathing easily while they sleep allow them to feel rested and well in ways they had not felt for years before.

A mandibular advancement device, or MAD, is a dental device, custom fit to hold the jaw forward at night. By locking the top and bottom teeth together, the lower jaw, and therefore the tongue, cannot slide back and block the throat when the wearer falls asleep.

A recent report in Science World Report highlighted the fact that children are also at risk for obstructive sleep apnea. Snoring in babies and children is no more normal, cute or funny than it is in adults.

Habitual snoring signals airway obstruction and potential for long term physical and mental health problems as well as developmental delays and learning disabilities. Large tonsils are often found to be the culprit in children and a tonsillectomy can be completely curative.

Patty Tucker, a medical practitioner for over two decades, has specialized in sleep medicine since 2001.