From Dr. Sachin Kumar
Snoring habitually can cause serious health problems, including obstructive sleep apnea. Recent studies have shown that nearly 80 percent of high blood pressure cases, 60 percent of strokes, and 50 percent of heart failure are cases of undiagnosed sleep apnea
All too often, snoring is viewed as a nuisance rather than a real health problem. Snoring is often treated as a ridiculous nuisance. Even so, snorers – and the partners who have to listen to their snores at night – usually have no problem acknowledging that snoring is bothersome and uncomfortable. While there is no hard and fast definition of snoring, it is generally accepted that the term refers to a breath sound that occurs during night or day sleep and can be inspiratory, expiratory, or both.
What causes snoring?
Snoring occurs when the flow of air through your mouth and nose is physically obstructed. Airflow can be impeded by a combination of factors including:
Obstructed nasal airways: Some people only snore during allergy season or if they have sinus infections. Malformations of the nose such as a different nasal septum or nasal polyps can also cause this.
Poor muscle tone in the throat and tongue: The muscles of the throat and tongue can be too relaxed, causing them to collapse and fall back into the airways. This can be caused by deep sleep, drinking alcohol, and taking sleeping pills. Aging leads to further relaxation of these muscles.
Bulky neck fabric: Obesity can lead to thick neck tissue. Children with large tonsils and polyps also often snore.
Long soft palate and / or uvula: A long soft palate or uvula (the dangling tissue at the back of the mouth) can narrow the opening from the nose to the throat. When these structures vibrate and collide, the airways become blocked, which leads to snoring.
Although 30-40 percent of adults snore while they sleep, little society is aware of the potential harm of a seemingly harmless habit. Habitual snores can experience serious health problems, including obstructive sleep apnea (cessation of breathing for 10 seconds or more OSA), of which a snorer can have 100 or more episodes while sleeping. Snoring – with or without sleep apnea – is a very serious health concern.
Snoring is a sign of insomnia that can lead to many health problems. It causes sleep deprivation, sleep fragmentation, and the loss of sleep architecture. The prevalence of OSA in various community-based Indian epidemiological studies is similar to that of the western population. From South Delhi the prevalence and risk factors of OSA in different socio-economic classes of an Indian urban population were reported. The authors observed a prevalence of OSA of 9.3 percent. The prevalence rates of OSA in men and women were 13.4 percent and 5.6 percent, respectively.
Obstructive sleep apnea causes several problems
Breathing interruptions (from a few seconds to minutes) during sleep due to partial or complete obstruction of the airways.
Waking up from sleep frequently, even if you may not realize it.
Light sleep. Waking up frequently can result in more time being spent in light sleep than in restful, deeper sleep.
More and more scientific studies show a connection between poor sleep quality and inadequate sleep in a variety of diseases. Blood pressure is variable during the sleep cycle; however, interrupted sleep negatively affects normal variability. Recent studies have shown that nearly 80 percent of high blood pressure cases, 60 percent of strokes, and 50 percent of heart failure cases are actually cases of undiagnosed sleep apnea. Research shows that inadequate sleep affects the body’s ability to use insulin, which leads to the onset of diabetes. Fragmented sleep can lead to decreased metabolism and increased levels of the hormone cortisol, leading to increased appetite and decreased ability to burn calories.
Bad night’s sleep. This leads to drowsiness during the day and can affect your quality of life.
One of the reasons sleep apnea is underdiagnosed is because it occurs while sleeping. Most adults who snore and have sleep apnea continue to deny that they have any problems. Clinical manifestations of obstructive sleep apnea can be divided into nocturnal and daytime symptoms. Of course, at the top of the nocturnal symptoms is very loud snoring. The other nocturnal symptoms are fragmented sleep, troubled sleep, stopped breathing while sleeping, gasping for breath or suffocation, oesophageal reflux, dry mouth, nocturia, palpitations, and nightmares to name a few. Daily symptoms are morning headache, daytime sleepiness, fatigue, depression and mood swings, sexual dysfunction as a result of hypoxemia, hearing loss, cognitive deficits, automatic behavior, decreased mental alertness and short-term memory loss, hallucinations and even family disputes. Systemic consequences of apnea can be high blood pressure, cardiac arrhythmias, systemic and pulmonary hypertension, myocardial infarction and stroke.
Not all have sleep apnea
In fact, studies show that most snorers do not have sleep apnea. One of the most stringent tests, published in the New England Journal of Medicine in 1993, tested habitual snorers ages 30 to 60 and found no signs of sleep apnea in 81 percent of female snores and 66 percent of male snorers. But 7 percent of female snores and 17 percent of male snorers had severe apnea, which means that their breathing stopped at least 15 times an hour. So how do you know if yours is the dangerous species?
You can’t find out by yourself. It is really important to have it checked out by a doctor.
Inexplicable daytime sleepiness, even without snoring, is the reason for a sleep study.
Second hand snoring
Research shows that people who sleep next to a snorer experience more pain symptoms, have higher levels of fatigue and sleepiness, and may even have a higher risk of hearing loss.
Treatment can improve snoring in some cases, but a complete cure is not always possible.
Lifestyle changes, such as losing weight, are usually recommended.
Anti-snoring devices such as mouth guards or nasal strips can help prevent snoring. When you’re experiencing severe apnea, CPAP is the gold standard: continuous positive airway pressure. You wear a mask or nosepiece attached to a small machine that delivers even, mild air pressure to help keep your airways open while you sleep.
Some people try to remove excess tissue from the throat or roof of the mouth, or move their jaw or tongue. Snorers, with and without sleep apnea, can do other things to help themselves: Change their sleeping position. People snore more when they sleep on their backs. So try to sleep on your side. If you keep finding yourself on your back, try tying a tennis ball to your back or buy a pillow to prevent sleeping on your back.
Maintain sleep hygiene. For better sleep, it’s important to have the right atmosphere, including a relaxed mind, calm and comfortable surroundings, and less stimulating activities. Avoid alcohol. Muscle relaxants and other medications that may relax your airways and contribute to snoring.
(The author is Consultant Pulmonology and General Medicine, Narayana Multispeciality Hospital, Bengaluru)
What the boffins are saying
A 2007 study by the University of British Columbia observed a “significant” difference between workers with mild OSA and severe OSA. It affected their interpersonal relationships, their performance, and their time management. They concluded that excessive sleepiness and lower work productivity are strongly correlated.
A 2013 study in Brazil found that obstructive sleep apnea syndrome (OSAS) increases the risk of accidents at work and can therefore negatively impact the economy. It suggested the use of oral aids to improve labor productivity, but found no evidence that these aids could reduce accidents.