Are you troubled by your bed partner’s loud snoring while asleep? Snoring may not always be as harmless as you think. Snoring accompanied with repeated stops and starts in breathing can be an alarming and life threatening condition. This is why snoring should not be dismissed and a visit to an experienced ENT specialist to understand and investigate the reason for your loud snoring is recommended.
Dr. Annabelle Leong is a leading ear, nose and throat specialist in Singapore. She has had her training at some of the best ENT centres in the UK, Canada and Singapore and has extensive experience with sleep apnea patients. Below she shares some information on sleep apnea.
What is Sleep Apnea?
It is a serious sleep disorder where an individual’s breathing is interrupted while sleeping. When sleep apnea is not treated, the supply of oxygen to the brain and the rest of the body is not sufficient due to repeated pauses in breathing.
Sleep apnea has two types. The more common form is obstructive sleep apnea, which is caused by a blockage in the airways. It could happen when during sleep the soft tissues at the back of the throat collapse. The other type is central sleep apnea. Unlike the former, in this case the brain fails to signal the muscles to breathe. This could be due to instability in the respiratory control centre.
Am I at a higher risk of developing sleep apnea?
This condition is not just limited to adults, but it can occur in children too. The following factors pose a higher risk for sleep apnea:
- Obesity
- Men have a greater risk than women
- Individuals over 40 years of age
- Having a small jaw bone and a large tongue and tonsils
- Family history of sleep apnea
- Deviated septum and other nasal obstruction indications like chronic allergies and sinusitis.
How do I know if I have sleep apnea?
Loud snoring is just one indication. This is best confirmed by your bed partner. However, all individuals who snore do not have sleep apnea and in some rare cases sleep apnea may be present even without snoring.
Sleep apnea causes disturbances in sleep. It is important to see if breathing becomes shallow and there are pauses in breathing from time to time. It is not easy to identify on your own and this confirmation might have to come from your partner. Some of the other common signs to watch out for are:
- Fatigue and sleepiness during day time
- Loud snoring to wake others up near you
- Dry throat on waking as breathing happens through the mouth.
- Frequent sore throats
- A dry mouth
- Suddenly waking and sleeping with a gasping sensation.
- Restlessness and insomnia
- Lack of energy during the day even after a complete night’s sleep
- Sleepiness when driving
- Morning headaches due to lack of sleep and breathing problems.
- Forgetfulness, loss of interest in daily activities and irritability. This is due to lack of sleep.
- Dizziness on waking and it can be linked to low oxygen levels.
- Nightmares
If you have these symptoms, then early intervention is important. Consult your ENT doctor to have a diagnosis and treatment plan.
What can untreated sleep apnea do?
Sleep apnea if left untreated can lead to these conditions:
- Hypertension
- Headaches
- Stroke
- Heart failure with irregular heart beats and attacks
- Depression
- Diabetes
What tests are performed to confirm if I have sleep apnea?
If the doctor feels that sleep apnea is present, then you may be asked to have a polysomnogram or a sleep apnea test. This test is being conducted at the medical clinic or you can now even get one done from home. A sleep study records physical activities when you sleep and the recordings are analysed by a sleep specialist. This study will help to determine the type of sleep disorder you have. If the results from the sleep test points towards sleep apnea, then more tests may be done.
Some of the other tests performed:
- EEG: This helps to measure and record brain wave activity
- EMG: This helps to record muscle activity like face twitches, leg movements. It would help to look for REM stages of sleep.
- EOG: (electrooculogram) This helps to record eye movements. It can determine the stages of sleep.
- EKG: This records heart rate and rhythm.
- Nasal airflow sensor helps to record airflow.
- Snore microphone helps to record snoring activity.
What are the treatment options available?
The first process in initiating treatment will be conservative management to see if the condition improves. Thus, changes to lifestyle and treating underlying conditions will be done as a first step. Some of the suggested initial steps include:
- Losing weight: More than 50% of the people with sleep apnea are obese and the first advice by the doctor is in losing the extra pounds. Losing weight will help to remove the extra tissues in the throat.
- Quitting alcohol and sleeping tablets: Alcohol causes the throat muscles to relax and collapse which can interfere with the air flow. This is also true with sleeping pills and it should be avoided.
- Changing sleep positions: Breathing is easier when you stay off your back.
- Quitting smoking: Sleep apnea and snoring is made worse by the contents of cigarette smoke.
- Chronic condition treatment: Nasal allergies, congestion as well as sinusitis needs treatment. This helps to relieve the inflammation of the airways. These chronic conditions cause breathing to be harder and nasal passages to be narrower. An ENT doctor can help to control these conditions.
Other treatment options involve the use of devices and this includes:
- Continuous positive airway pressure (CPAP) : A mask is worn over the nose and mouth when sleeping. This mask is hooked to a machine which delivers a constant air flow to the nose. This continuous air flow helps to keep the airways open, helping in breathing. This is the most common treatment type.
- Bilevel Positive Airway Pressure: This is like CPAP, but the airflow levels change when you breathe in and out.
If the above methods are not working, then surgery may be the only remaining option for sleep apnea. This is particularly important when there are enlarged tonsils or a deviated septum in the patient.
- Nasal surgery to fix nasal issues like a deviated septum.
- Uvulopalatopharyngoplasty: In this procedure, soft tissues from the back of the throat are removed making way for the airway to get wider at the opening of the throat.
- Mandibular maxillomandibular advancement surgery: It helps in fixing facial problems or throat blocks which play a role in sleep apnea.