Part 2 of a Ten-Part Series

Sleep research, just as with space and ocean exploration, help us uncover answers to what has been a complex mystery. Sleep medicine is in its infancy, but this field has also benefited from the major technological advances made over the past few decades. To date, sleep researchers have identified approximately 80 different sleep disorders. Of these disorders, snoring and sleep apnea are the most prevalent.

What causes snoring?

Snoring is viewed by most as a social nuisance. In reality, snoring is a medical symptom for something as simple as the common cold -- to something as potentially life-threatening as severe sleep apnea. Snoring is the sound made by air passing through irregularities and narrowings in the throat and windpipe. Snoring can occur when someone breathes in or breathes out. Snoring in itself is not dangerous, but it can be the first stage in the development of apnea. Weight gain, sedation or anything else that further constricts the oropharyngeal airway could turn a chronic snorer into a sleep apnea patient.

Should snoring be treated?

Those who snore should be seen by a doctor to determine if the snoring may result in cardiopulmonary consequences, such as high blood pressure or episodes of sleep apnea. But, there may be ways of reducing a person’s snoring without major medical intervention. There is nothing wrong, for example, with trying to ask an otherwise healthy snorer to change sleeping positions. As a matter of fact, it is a good sign if a change of position -- rolling over on the side, for instance -- will stop a person’s snoring. If snoring stops when sleeping on their side, doctors suggest special pillows or a tennis ball sewn into the back of the pajama top.

For more severe snoring that cannot be remedied by simple measures, a doctor may suggest other treatments, such as dental appliances, breathing strips, or an outpatient procedure to remove or reduce excessive or obstructive tissue in the back of the throat or upper palette.

Light snoring may be a minor nuisance, but when snoring becomes loud and disruptive, and when it is accompanied by extreme sleepiness or sleep attacks during the daytime, it should be taken seriously. If snoring involves a repetitious cycle of “snore, pause, snort” or, in other words, the person snores, stops breathing for a few seconds and starts again with a loud snort, the sleeper most likely suffers from sleep apnea and should seek the immediate treatment of a qualified doctor.

What is sleep apnea?

Sleep apnea is a condition that was discovered only recently (in 1965, in Europe). Between 70 and 90 percent of those who suffer from it are men, mostly middle-aged, and usually overweight. The vast majority snore heavily. The problem is a neuromuscular one that results in the partial closing of an airway called the nasal pharynx while one sleeps. Up to 10% of the male population, up to 5% of all adult women, and up to 40% of all Americans over the age of sixty may suffer from some form of sleep apnea.

How do you recognize the signs of apnea?

Those who suffer from sleep apnea actually stop breathing as they sleep -- perhaps as often as several hundred times per night. Patients seem to gasp for breath in their sleep, and the oxygen level in their blood becomes abnormally low. In severe cases, the patient may actually spend more time not breathing than breathing.

Those who suffer from apnea do a lot of loud and intermittent snoring during the night. They may have the sensation of choking, and may move about a great deal while in bed. Excessive sweating often occurs during sleep. There often is an irregular pounding of the heart as the patient gasps for breath.

People who have sleep apnea may suffer from early-morning headaches and feel excessively sleepy throughout the day. Hallucinations sometimes occur while the patient is awake but feeling extremely sleepy. Memory deterioration, personality changes, and impotence are common. Rapid weight gains, often approaching obesity, often occur.

Sufferers are hard to awaken, and if they are suddenly awakened, they frequently do not know where they are. Upon awaking, those who suffer from the "snoring sickness" usually will not recall having experienced an apneic episode in their sleep. A period of disorientation sometimes occurs immediately after waking. During such periods, the individual may have difficulty with his memory and give inappropriate answers to questions, acting as if he did not hear it or failed to understand what was asked.

What can occur if apnea goes untreated?

Sleep apnea may produce fatal pulmonary and cardiovascular complications. Cardiovascular problems resulting from the illness may include blood pressure, irregular heart rhythm, or deterioration of the heart muscle and its ability to pump blood, which can result in heart failure, heart attack or stroke.

Apnea patients have twice the usual prevalence of hypertension, three times as much heart disease, and four times as much cerebrovascular disease. Other potential consequences include stroke, neuropsychiatric problems, cognitive impairment, sexual dysfunction, and injury due to accidents. Once a person develops sleep apnea, he appears to have it for life.

At least a million people are severely impaired by the ailment, and twice that many are partially impaired. Unfortunately, 95% of them remain undiagnosed and untreated.

How is apnea diagnosed?

Any person who suspects they may have sleep apnea should ask their family doctor for a referral to a doctor who specializes in sleep disorders. If referred to a sleep specialist, the doctor will obtain a medical history and ask sleep-related questions, may perform a physical examination, and may ask to interview the patient’s bed partner. If the sleep specialist feels an overnight sleep study is indicated, the patient may be referred to a sleep lab at the nearest hospital. In the sleep lab, the patient’s brain waves, muscle activity, leg and arm movements, heart rhythms, and other body functions will be monitored during sleep. With this information, the doctor can properly diagnose the patient’s condition and begin the patient on an appropriate treatment plan.

How is apnea treated?

Physicians usually treat sleep apnea by providing pressure support for the walls of the airway during sleep with a technique called continuous positive airway pressure given through the nose -- nasal CPAP for short. While the idea of wearing such a mask all night long may seem unappealing, most patients learn to use CPAP quickly and adapt to wearing the device whenever they sleep. The vast improvement in the quality of the patient’s life seem to far outweigh any inconveniences. In some cases where an abnormality is involved, surgical widening of the airway or repositioning of the jaw may be needed. For less serious cases, weight reduction, respiratory stimulants, drugs to increase muscle tone in the back of the throat, and dental appliances may be the recommendation of the doctor.