Snoring and Sleep Apnea
Millions of Americans have sleep-related difficulties, of which snoring and sleep apnea are the most common. Both snoring and sleep apnea are forms of obstruction of breathing.
Snoring is the hoarse or harsh sound that occurs when your breathing is partially obstructed in some way while you’re sleeping. Sometimes snoring may indicate a serious health condition. In addition, snoring can be a nuisance to your partner.
As many as half of adults snore sometimes. Snoring occurs when air flows past relaxed tissues in your throat, causing the tissues to vibrate as you breathe, which creates those irritating sounds.
Lifestyle changes, such as losing weight, avoiding alcohol close to bedtime or sleeping on your side, can help stop snoring.
In addition, medical devices and surgery are available that may reduce disruptive snoring. However, these aren’t suitable or necessary for everyone who snores.
Depending on the cause of your snoring, your symptoms may include:
- Noise during sleep
- Restless sleep
- Excessive daytime sleepiness
- Gasping or choking at night
- Difficulty concentrating
- High blood pressure
- Sore throat
- Chest pain at night
See your doctor if:
- Your snoring is so loud it’s disrupting your partner’s sleep
- You wake up choking or gasping
- These may indicate your snoring is caused by a more serious condition, such as obstructive sleep apnea.
- If your child snores, ask your pediatrician about it. Children can have obstructive sleep apnea too. Nose and throat problems — such as enlarged tonsils — and obesity often can narrow a child’s airway, which can lead to your child developing sleep apnea. Treating these conditions may help your child in many ways.
Many factors, such as the anatomy of your mouth and sinuses, alcohol consumption, allergies, a cold, and your weight, can lead to snoring.
When you doze off and progress from a light sleep to a deep sleep, the muscles in the roof of your mouth (soft palate), tongue and throat relax. The tissues in your throat can relax enough that they partially block your airway and vibrate. And, the more narrowed your airway, the more forceful the airflow becomes. This causes tissue vibration to increase, which causes your snoring to grow louder.
The following conditions can affect the airway and cause snoring:
- Your mouth anatomy. Having a low, thick soft palate can narrow your airway. People who are overweight may have extra tissues in the back of their throat that may narrow their airways. Likewise, if the triangular piece of tissue hanging from the soft palate (uvula) is elongated, airflow can be obstructed and vibration increased.
- Alcohol consumption. Snoring also can be brought on by consuming too much alcohol before bedtime. Alcohol relaxes throat muscles and decreases your natural defenses against airway obstruction.
- Nasal problems. Chronic nasal congestion or a crooked partition between your nostrils (deviated nasal septum) may contribute to your snoring.
- Sleep apnea. Snoring also may be associated with obstructive sleep apnea. In this serious condition, your throat tissues partially or completely block your airway, preventing you from breathing.
Sleep apnea often is characterized by loud snoring followed by periods of silence when breathing stops or nearly stops. Eventually, this reduction or pause in breathing may signal you to wake up, and you may awaken with a loud snort or gasping sound. You may sleep lightly due to disrupted sleep. This pattern of breathing pauses may be repeated many times during the night.
People with sleep apnea usually experience periods when breathing slows or stops at least five times during every hour of sleep.
Habitual snoring may be more than just a nuisance. Depending on the cause of your snoring, it may result in:
- Daytime sleepiness
- Frequent frustration or anger
- Difficulty concentrating
- A greater risk of high blood pressure, heart conditions and stroke
- An increased risk of behavior problems, such as aggression or learning problems, in children with obstructive sleep apnea
- An increased risk of motor vehicle accidents due to lack of sleep
- Disruption of bed partner’s sleep
Risk factors that may contribute to snoring include:
- Being a man. Men are more likely to snore or have sleep apnea than are women.
- Being overweight. People who are overweight or obese are more likely to snore or have obstructive sleep apnea.
- Having a narrow airway. Some people may have a long soft palate, or large tonsils or adenoids, which can narrow the airway and cause snoring.
- Drinking alcohol. Alcohol relaxes your throat muscles, increasing the risk of snoring.
- Having nasal problems. If you have a structural defect in your airway, such as a deviated septum, or your nose is chronically congested, your risk of snoring is greater.
- Having a family history of snoring or obstructive sleep apnea.
Sleep apnea is a serious sleep problem. If you have it, you stop breathing for more than 10 seconds at a time many times while you sleep. Another term for this problem is obstructive sleep apnea. Sleep apnea affects between 2 and 10% of people. It is more common in men than in women. It is also more common in people who are overweight, but there are many people with normal weight who have sleep apnea.
How does Sleep Apnea occur?
During normal sleep, throat muscles relax. If, when this happens, there is too little room inside your throat, or too much tissue pressing on the outside of your throat, your airway can become blocked. This blockage stops the movement of air and the amount of oxygen in your blood drops. The drop in oxygen causes the brain to send a signal for you to wake up so that you open up the airway in your throat and start breathing again. If you have sleep apnea, this cycle may repeat as often as 50 or more times an hour. Generally you will not remember waking up but the many arousals will make you sleepy the next day.
Being overweight may cause a narrowing of your airway. Other possible causes of sleep apnea are:
- Tobacco smoking
- Drinking a lot of alcohol
- Lung disease
- An abnormal sleep pattern because of an irregular work schedule or rotating shift work Some people inherit a tendency to have sleep apnea.
If you have sleep apnea, your body gets less oxygen when you sleep and you don’t sleep well.
Common symptoms of sleep apnea are:
- Loud snoring interrupted with pauses in breathing followed by loud gasps
- Not feeling rested when you wake up in the morning
- Morning headaches
- Tiredness or sleepiness during the day
- Trouble concentrating
- Anxiety, irritability, or depression
- A strong desire to take afternoon naps
- Sleepiness while driving.
Many people who snore do not have sleep apnea, but nearly everyone who has sleep apnea snores. If you snore and feel you do not usually get a good night’s rest, you should ask your health care provider if you might have sleep apnea.
To accurately diagnose, your health care provider may:
- Ask you about your health history and your family’s health history.
- Examine you, especially your throat and nasal passages.
- Do a sleep study at a sleep disorders clinic or sleep lab. Your heart rate, brain waves, chest movement, and blood oxygen levels will be measured while you sleep. The study will help determine if the movement of air slows during sleep or if your air movement stops completely during sleep. It will also show how often this happens during sleep.
Treating sleep apnea is very important. Untreated sleep apnea can have very serious long-term effects on your health. It may increase your risk of high blood pressure, heart attacks, and sudden death. Effective treatment of sleep apnea may result in normal blood pressure, relief of fatigue, and weight loss.
The most common treatment is use of a machine that sends pressurized air into your nose and throat at night. How much pressure you need is determined by the sleep study. Your health care provider will carefully supervise your use of this breathing machine because minor adjustments may need to be made so it works right for you. This treatment is called continuous positive airway pressure (CPAP).
If you have pressure on your throat because of excess fatty tissue in your throat, your health care provider may suggest a weight-loss program. It may be hard for you to lose weight because you are extremely tired and lack energy to exercise. Use of the breathing machine may help you rest well enough to begin changes in your diet and to increase your physical activity so you can lose weight.
Surgery may be an option if you cannot use the breathing machine regularly and properly. A surgical treatment might include improving the air passage in the nose, removing the tonsils, or moving the back of the tongue forward.
Other possible treatments currently being studied are:
- Medicines that change the brain chemistry and help muscle tone increase during sleep
- Pacemakers that sense when blockages are occurring and stimulate throat muscles to open up the throat before you wake up.
It is too early to say if these experimental treatments will become acceptable treatments of sleep apnea.
If your sleep apnea is caused by a reversible problem, such as overweight, or if it can be treated with surgery, your sleep apnea can be cured. For most people, however, sleep apnea will always be a problem and the CPAP machine will need to be used regularly to get good quality sleep and to prevent the serious complications of sleep apnea.
How can I take care of myself?
- If you think you may have sleep apnea, see your health care provider.
- If you are being treated for sleep apnea, make sure you go to all your follow-up appointments with your provider.
- If you lose or gain a lot of weight or have new symptoms, talk to your provider to see if you need to change your treatment.
How can I help prevent sleep apnea?
Proper weight control, exercise (according to your health care provider’s recommendations), good sleeping habits, not smoking, and avoiding excessive alcohol use will help you have general good health and may help prevent sleep apnea.