Dreaming of A Peaceful Sleep?
There is hope for relief from sleep apnea and snoring!

By Dagmar Gross

Snoring is usually either a source of humour or a source of irritation for the snorer’s sleep partner. Three years ago, my father’s snoring was both. He snored so loudly my mother had to move to another bedroom to sleep. Often he stopped breathing for several seconds, only to begin snoring again with a huge snort. He was an irritable, tired man with a failing memory and frequent headaches. He dozed off whenever he sat down to read or watch television.

Snoring occurs in about 40 per cent of the population and affects both men and women, particularly those over 40. In fact, 60 per cent of men and 40 per cent of women over age 60 snore ^1,2. Made worse by excess weight, smoking, alcohol intake and sedative use, the snoring sound is created when the soft tissues at the back of the mouth relax during sleep and vibrate. About one-third of snorers also suffer from sleep apnea, where the upper airway becomes obstructed, and they stop breathing for more than 10 seconds, at least five times each hour ¹. In extreme cases, sleep apnea sufferers may stop breathing for almost two minutes, and have up to 300 episodes per night.

Snoring and sleep apnea are risk factors for many cardiovascular disorders, including hypertension, heart failure and stroke ^3,4,5. Severe cases of sleep apnea may lead to death, either due to heart attack or stroke, or from falling asleep while driving or handling other machinery.

Signs and symptoms of sleep apnea include: noisy snoring interrupted by periods of silence and a loud, excessive daytime sleepiness (dozing off while reading, watching television or driving), waking up feeling unrefreshed, morning headaches, decreased cognitive function and concentration, poor memory, aggressiveness and irritability, high blood pressure, heartburn, problems controlling body weight, reduced sex drive or impotence, a feeling of choking or gagging during sleep, heavy sweating or frequent urination at night ^6,7. If someone exhibits four or more of these symptoms, a referral to a sleep disorder clinic may lead to treatment for some relief.

Several treatments exist to control or reduce snoring and sleep apnea. A physician will first recommend that the patient lose weight, stop smoking (to reduce irritation and swelling of the upper airway), avoid eating late at night and avoid alcohol, sedatives and antihistamines, which relax the muscles and soft tissues of the throat.

A doctor may recommend Continuous Positive Air Pressure (CPAP), which is applied by a small pump and nose mask while the patient sleeps and keeps the air passages open. CPAP is 100 per cent effective in treating sleep apnea, and after eight weeks of therapy patients report a substantial improvement in their vitality, social function, memory and mental health ^8,9. Possible treatment side effects include dryness or infection of the nasal passages and sleep partner disturbance.

Surgery for snoring and sleep apnea, performed by an ear, nose and throat specialist, reduces the loose tissue at the back of the throat. This kind of surgery involves an overnight hospital stay, and the patient has a sore throat for about two weeks. Laser surgery can be performed at the specialist’s office with a local anesthetic, with no bleeding, less pain, and less complications. Approximately half of surgery patients experience a substantial reduction in breathing interruptions regardless of how severe their sleep apnea ¹⁰. The type of surgery performed and its effectiveness as treatment depend on identifying exactly which are the problem tissues ¹¹.

Another treatment includes a dental appliance specially designed by the dentist to fit the teeth and jaw. The method is 75 to 85 per cent effective in treating mild to moderate sleep apnea ^12,13,14. It holds the tongue forward or repositions the jaw downward and forward, which keeps the airway open during sleep. This device depends on healthy, stable teeth or fixed dentures to stay in place and is therefore not appropriate for patients with arthritis or growing children (as their teeth and jaw structure are still developing).

As there are many options for effectively treating snoring and sleep apnea, for those who may be seeking relief, ensure the doctor discusses all possibilities with you before making a final decision. Today, after being diagnosed with severe sleep apnea and receiving appropriate treatment with CPAP, my father is a vibrant, positive, energetic man, who once again is enjoying life.

References:

1. Fairbanks D. Snoring: An Overview with Historical Perspectives. Snoring and Sleep Apnea, 2 Ed. 1994:1-16.

2. Soto F. Cardiovascular manifestations of obstructive sleep apnea. Rev Med Chil. 1998. 126:1112-1116.

3. Koskenvuo M, et al. Snoring as a risk factor for hypertension and angina pectoris. Lancet. 1987. i:893-896.

4. Koskenvuo M, et al. Snoring as a risk factor for ischaemic heart disease and stroke in men. Br Med J. 1987. 294:16-19.

5. Shepard J, Jr. Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. Clin Chest Med. 1991. 13:437-458.

6. Diagnostic Classification Steering Committee of the American Sleep Disorders Association. The International Classification of Sleep Disorders: diagnostic and coding manual. 1990.

7. Guilleminault C. Clinical Features and Evaluation of Obstructive Sleep Apnea. Principles and Practice of Sleep Medicine. 1994:667-677.

8. Ballester E, et al. Evidence of the Effectiveness of Continuous Positive Airway Pressure in the Treatment of Sleep Apnea. Am J Respir Crit Care Med. 1999. 159:495-501.

9. D’Ambrosio C, et al. Quality of life in patients with obstructive sleep apnea: effect of nasal continuos positive air pressure. Chest. 1999. 115:123-129.

10. Walker RP, et al. Laser-assisted uvulopalatoplasty for the treatment of mild, moderate, and severe obstructive sleep apnea. Laryngoscope. 1999. 109:79-85.

11. Barthel SW, Strome M. Snoring, obstructive sleep apnea, and surgery. Med Clin North Am. 1999. 1:85-96.

12. Schmidt-Nowara W, et al. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep. 1995 18:501-510.

13. Cartwright R, et al. Toward a treatment logic for sleep apnea: the place of the tongue retaining device. Behav Res Ther. 1988. 26:121-126.

14. Clark G. Management of obstructive sleep apnea with dental appliances. Calif Dent Jour. 1988. 16:26-33.

"Copyright © 1999 WOMAN Newsmagazine. Reprinted by permission."