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Brandon Peters, M.D.

30 Days to Better Sleep: Snoring and Sleepiness Equals Sleep Apnea

By January 23, 2013

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In reviewing the articles in this blog series, you may have become convinced that the only thing that affects sleep is not sleeping as part of insomnia. However, there are many other sleep disorders that can contribute to difficulty sleeping and waking refreshed. One of the major contributors to excessive sleepiness during the day is trouble breathing at night, best characterized by sleep apnea.

Sleep apnea occurs when the upper airway collapses during sleep. Tissues in the airway, from the nose past the soft palate to the base of the tongue, may obstruct the flow of air. When this occurs, this obstruction may be partial (hypopnea) or complete (apnea). It may be worsened by lying on one's back or during REM sleep when the body's muscles are actively paralyzed, including the muscles lining the airway. This soft, flexible tube is thus able to collapse and disrupt breathing. These events may occur as few as 5 times per hour or as many as hundred of times per night.

It may not matter much that the tissues at the back of the nose and mouth collapse during sleep. It wouldn't, that is, if our brain didn't recognize the problem. These disruptions to breathing trigger a panicked response from the brain. A burst of cortisol races through the body, while blood oxygen levels drop heart rate spikes, and sleep is briefly disrupted to restore breathing. This brief arousal is transient, lasting only seconds, but it shifts the brain from deeper stages of sleep to lighter ones, and often fully to wakefulness. Sleep becomes fragmented and the restorative properties diminish.

As a result, people with sleep apnea do not feel refreshed when they wake in the morning. Quite the contrary, they may even feel worse after sleeping. Whatever good is to come from sleep is lost. Upon awakening, there may be morning headaches and a strong desire to return to bed (sleep inertia). Later in the day, someone with sleep apnea is plagued by excessive daytime sleepiness; a "mental fog" with poor concentration, attention, and short-term memory; and mood issues including depression and irritability. There are serious health consequences to this fragmented sleep, including hypertension, diabetes, high cholesterol, memory loss, stroke, heart attack, and sudden death. This is a serious business, but it doesn't have to be.

How do you know if you have sleep apnea? People who snore at night have an airway that is narrow with the turbulent airflow causing a vibration that is heard as snoring. When this air stops flowing, apnea occurs. A careful observer may note pauses in breathing, lasting more than 10 seconds, followed by a sudden snort or gasp and return to snoring. When experienced, someone with apnea may wake up gasping or choking. (Incidentally, children should never snore and they often have undiagnosed or misdiagnosed sleep apnea with hyperactivity, attention problems, and growth restriction.) In adults, this condition can run in families due to upper airway anatomy and facial structure. It is worsened by weight gain, alcohol use, and smoking. In women, menopause may signal a time when sleep apnea worsens or first becomes evident. In anyone who is predisposed, aging and the associated loss of muscle tone can also exacerbate the condition.

Fortunately, there are effective treatment options for sleep apnea, including the preferred therapy called continuous positive airway pressure (CPAP). It works by maintaining the airway open with a constant flow of air. Though there can be initial hurdles, once these are overcome, CPAP can make a world of difference. There are no major side effects, and it can leave you sleeping and functioning a lot better.

If you snore at night and suffer from excessive daytime sleepiness (with a score higher than 10 on the Epworth sleepiness scale), you should seek evaluation for possible sleep apnea. If you have witnessed pauses in your breathing and are too sleepy, you almost certainly have sleep apnea. Treatment can be highly effective, so do yourself a favor and get checked out by a sleep doctor. Curing your sleep apnea is most certainly a major way to sleep better.

Check out the entire series, "How to Sleep Better in 30 Days."

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