By Dr Annabelle Leong
Did you know that persistent snoring usually means that your airway is obstructed? When you snore, it means that you’re not breathing well. This then affects your sleep quality, in turn leading to a whole host of other health problems. It’s a very long list of complications related to untreated sleep apnea. There is also a long list of symptoms and signs to watch out for in people who can’t stop snoring!
WHAT ARE THE COMMON REASONS FOR SNORING?
Although it’s usually the men who keep snoring, we see a few ladies too who suffer from persistent snoring. Snoring occurs when ANY part of your airway is blocked or collapses to prevent air from entering normally. Imagine your airway being a long passage but this “tunnel” has multiple levels of potential narrowing. The levels of airway narrowing could range from the nose and back of the nose, to the palate and throat. Sometimes, the tongue may be large enough to fall backward to block off your airway.
If you wake up at night repeatedly or make strange gasping and choking noises, this is definitely ABNORMAL! There is quite a strong chance that you have moderate to severe obstructive sleep apnea, with these worrying symptoms. The more severe your sleep apnea and snoring, the more you will sound like you are “dying in your sleep”. Your sleep partner is the best person to detect this so if they keep commenting on your noisy disturbed sleep patterns, please listen to them and see an experienced ENT specialist in Singapore. Stop snoring and learn how to sleep better!
So the above picture shows you the normal airflow entering your airway on the left hand side. The airway on the right is blocked due to airway obstruction from the tongue and soft palate collapsing backward. Can you imagine trying to breathe like this in your sleep every night for many years? Well, that is exactly what many snoring patients do not realise while their condition just keeps worsening.
WHY SHOULD I BE CONCERNED ABOUT SNORING AND SLEEP APNEA?
Where should I start? There are so many potential complications which can develop over a prolonged period of sleep apnea and airway obstruction. For example, your blood pressure may become persistently elevated to cause hypertension. Sleep apnea and hypertension are both risk factors for heart disease, not just heart attacks but may cause arrhythmias, which are irregular heart rhythms. This in turn could lead eventually to heart failure.
The risk of suffering a stroke is also significantly higher in sleep apnea patients. You can understand why as the heart is “stressed” from having to work harder to maintain a steady blood oxygen level while you sleep fitfully with sleep apnea.
If you are diabetic and also suffer from sleep apnea, then there is a real risk that your impaired glucose tolerance is going to be more difficult to treat. Stress from the breathing difficulties experienced during poor sleep every night, is associated with elevated blood sugar levels. You may then required higher doses of your diabetic meds. By the way, the one thing you can do to help BOTH your diabetes and obstructive sleep apnea, is to LOSE WEIGHT! Studies show that those with impaired glucose tolerance may find a reversal back to normal blood sugar levels, with a careful diet and regular brisk exercise.
WHAT IS THE ROLE OF WEIGHT GAIN IN SNORING AND SLEEP APNEA PATIENTS?
With regard to weight control, those with sleep apnea may find their obstructive breathing symptoms worsen with weight gain. But conversely, sleep apnea patients may not be secreting normal levels of hormones to control their appetite. Hence this hormonal imbalance may lead them feeling more hungry daily. Testosterone levels in men who suffer from snoring and sleep apnea tend to be lower, leading to more “centralised” fat deposition around their tummies. Incidentally, perimenopausal women also notice this pattern of fat distribution too. This is an indicator of your visceral fat i.e. the fatty tissue layer on your internal organs, a reflection of your cardiovascular health.
When you gain weight, fatty tissue also grows as a layer of tissue inside your neck, potentially causing compression on your airway from the outside. Men who gain weight usually notice that their shirt collar size increases or that their waistband needs to be loosened. Lying flat on your back (supine) is the worst position for patients who keep snoring.
WHAT SIMPLE MEASURES CAN I DO TO STOP SNORING?
So what can you do to try to stop snoring and breathe better? We see many snoring patients at ENTcare Clinic Singapore, both adults and children.
From my experience with so many snoring patients, here are a few tips which I hope you will find helpful.
- SLEEP ON YOUR SIDE
- SLEEP WITH A HIGHER PILLOW
- AVOID ALCOHOL
- STOP SMOKING
- LOSE WEIGHT
- TRY USING NASAL STRIPS
- TRY USING A NASAL SPRAY
- SLEEP EARLIER AND PRACTISE GOOD SLEEP HYGIENE
WHAT TESTS DO I NEED TO INVESTIGATE HOW TO STOP SNORING?
Snoring patients usually seek the help of an ENT specialist who will examine their airway carefully to ascertain the levels of obstruction and collapse. Here is a typical sequence of events which the snoring patient would need to undertake:
- See the ENT specialist to have a quick “nose scope” done in clinic with a “numbing” anaesthetic nasal spray.
- Undergo a sleep study to screen for obstructive sleep apnea, usually done at home.
- Trial of nasal medications to decongest the nose.
- Discuss the test results with the ENT specialist in Singapore.
- Consider the options of surgical vs non-surgical interventions like CPAP.
- Go for a trial of CPAP and/or mandibular advancement device (“mouthguard”).
- If CPAP is not tolerated, then consider surgery to improve airway obstruction.
DO ALL SNORING PATIENTS NEED A SLEEP STUDY?
In theory, all snoring patients should have a sleep study to screen for underlying obstructive sleep apnea. This is a serious and potentially life-threatening health condition resulting from recurrent airway collapse when asleep. Patients stop breathing suddenly for a period of time, ranging from a split second to as long as 2 minutes. These pauses in their breathing are worrying and are called “apneas”.
We arrange the sleep study in the comfort of your home and usually just one overnight study is sufficient to capture enough sleep data. The sleep study looks at your breathing pattern, heart rate, sleep position, stages of sleep and more importantly, your blood oxygen levels. If your blood oxygen levels keep dipping, this is a worrying sign that you are not breathing well at all. Four hours of sleep data is usually adequate to provide a reliable sleep study report.
Despite the above, some patients just refuse to do a sleep study due to cost and time concerns. Some have already tried CPAP (Continuous Positive Airway Pressure) and could not tolerate CPAP. So they now come to see me to explore the surgical option for their nose and throat risk factors to Stop snoring.
WHAT SURGERY WOULD I NEED IF I DECIDE ON SURGERY TO STOP SNORING?
Snoring surgery usually consists of clearing the blocked nose and throat airways. I have written a very detailed blog on this already: “The Ultimate Guide to Snoring and how to Sleep Better”, so please click on this link to find out even more useful information!