Could Your Snore Mean Something More?

There’s a difference between making sounds in your sleep, and being a sound sleeper. When snoring is a sign of sleep apnea, that difference may have serious health implications. UR Medicine sleep specialist Dr. Carolina Marcus explains what sleep apnea is, who is at risk, and how it’s treated.

While most people who snore do not have sleep apnea, most people who have sleep apnea do snore—often quite loudly.

Sleep apnea is a potentially serious sleep disorder that occurs when a person's breathing is interrupted during sleep. There are two main types of sleep apnea: obstructive sleep apnea (OSA), where the upper airway becomes blocked repeatedly during sleep, leading to a reduction or complete stop in the airflow; and central sleep apnea, when the brain does not send the proper signals that are needed to breathe. We’ll focus on OSA, which is much more common.

Are You at Risk?

There are several factors commonly associated with OSA, including:

• Weight—People who are overweight or obese are more likely to have OSA than those that are at a healthy weight. The accumulation of excess fatty tissues in the neck, throat, and tongue can restrict the airflow through the upper airway as it becomes narrowed or pinched off during sleep.
• Age—The muscles in our throat lose tone as we age, which can make the airway more likely to collapse during sleep. In children, enlarged tonsils or adenoids are the leading cause of OSA.
• Gender—OSA is more common in men than women, until women reach menopause. A decrease in the production of certain hormones in menopause leads to a decline in muscle tone that makes it more likely to develop OSA.
• Genetics—Some people are genetically predisposed to having a narrower throat or an enlarged tongue that falls back into their airway. If your family has a history of OSA, you are more likely to have it.
• Drinking alcohol—Alcohol relaxes the throat muscles, potentially to the point of blocking the airway during sleep.
• Smoking—Tobacco smoke is an irritant to the lungs, throat, and esophagus. It can cause inflammation and fluid retention in the upper airways that can impede airflow.

Signs and symptoms that point to the possibility of OSA include snoring, gasping during sleep, waking up frequently during the night, excessive urination at night, night sweats, observed pauses or irregularities in breathing during sleep, morning headaches, unrefreshing sleep, dry mouth, sore throat, teeth grinding, and reduced sex drive. Daytime symptoms may include excessive sleepiness or fatigue, irritability, trouble concentrating, or memory loss.

Over time, many people with OSA develop high blood pressure, which can increase the risk of heart disease. The greater the severity of the sleep apnea, the greater the risk is of developing coronary artery disease, heart attack, or stroke. OSA can also lead to complications with your breathing and oxygen levels following anesthesia. Research has also demonstrated a link between OSA and glaucoma, a serious eye condition. OSA can also contribute to feelings of depression, mood swings, and irritability.

Diagnosis and Treatment

To test for OSA, a sleep medicine specialist takes a thorough health history and conducts a physical examination, including measuring your neck circumference and checking your blood pressure. If the provider suspects you may have OSA, they may recommend a nocturnal polysomnogram, an overnight sleep study at done at a sleep center. Under certain circumstances, they may recommend a home sleep apnea test, which is a simplified version of the polysomnogram.

If you’re diagnosed with mild OSA, a few lifestyle changes may be all it takes to turn it around. Losing weight, quitting smoking, reducing alcohol consumption (and not drinking for several hours before bedtime), and avoiding sleeping on your back can help.

For more serious cases, Continuous Positive Airway Pressure (CPAP) therapy is the most effective treatment.  A CPAP machine normalizes your nighttime breathing patterns, stops snoring and, in most cases, leads to more restful sleep.

In some cases, we recommend alternatives to CPAP, including dental appliances and surgical interventions. But for most patients, CPAP—in combination with weight loss, if appropriate for the individual—is the best treatment option.

Positional therapy can be an effective and simple treatment option for folks whose obstructive sleep apnea occurs mainly when they sleep on their backs. Positional therapy techniques may be used to promote sleeping on your side, and prevent sleeping on your back.

Surgery is usually considered only if other therapies haven't been effective or have not been tolerated by an individual despite their best efforts. A relatively new surgical option called Inspire is helping some people who have difficulty tolerating CPAP. Inspire is an implant that works very much like a pacemaker, monitoring every breath and stimulating the nerve that controls the movement of your tongue and other key airway muscles to keep them open during sleep.

Restful sleep is essential to good health. If you have any concerns about your sleep, the best first step is to discuss them with your primary care doctor.

Carolina Marcus, M.D., is an Associate Professor of Medicine at the UR Medicine Sleep Center. She is passionate about the field of sleep medicine and enjoys helping her patients identify the necessary tools to achieve better sleep. As a sleep medicine physician, Marcus diagnoses and treats patients with sleep apnea, insomnia, narcolepsy and other sleep-related conditions.