Obstructive Sleep Apnea is where there are episodes of blockage of the upper airway during sleep. These create a reduction in the level of blood oxygen and disturb your patter of sleep. It is very common, mostly undiagnosed and potentially very dangerous. It is a common cause of tiredness and day-time sleepiness.
If left untreated Snoring and Sleep Apnea has been shown to be associated with
|Heart Attacks||High Blood Pressure|
|Lethal accidents||Cardiac Arrhythmias|
|Depression||At times Sudden Death|
The physical obstruction of the flow of air through the mouth and nose is the cause of snoring. The obstruction may be because of deviated nasal septum, hypertrophied inferior turbinates, nasal polyps, poor tone of muscles of pharynx, bulky tongue and soft palate and long uvula. At times congestion of soft tissue due to smoking, alcohol and acid reflux may also contribute to narrowing of airway. Hypertrophy of tonsils and adenoid may also cause snoring and is more commonly seen in children.
Snoring is generated when soft tissue and muscles in the throat vibrates. During sleep, muscle tone in the throat and pharynx decreases causing a narrowing of the pharyngeal space, the required volume of air must be inspired at a higher velocity and noisy vibration of soft tissues like soft palate, uvula and at times tongue base causes the sound of snoring.
Patients with Sleep Apnea have interruption of breathing (more than 10 secs) during sleep due to blockage of airway and these episodes of Apnea may run even 100 times in some cases. They awaken frequently at night (not realizing it) resulting in poor quality of sleep leading to tiredness and lethergic in morning and excessive day time somnolence.
They have poor concentration at work, are more easily irritable and easily gets fatigue.
When a person obstructs at night and stops breathing, oxygen levels drop dramatically and hormones and adrenaline surge. Those hormones causes heart to pump harder leading to cardiovascular problems like high blood pressure, enlargement of heart, heart failures, heart attack and stroke and even sudden death. They usually suffers from high cholesterol level and diabetes.
Numerous studies show that Snoring from Sleep Apnea reduces survival. Over 20 years, you have a 70% change of reduced survival with sever Sleep Apnea compard to someone without.
The first step is to discuss your snoring and sleep problem with your doctor. It is a good idea to take your sleeping partner with you, to feel in the gaps regarding what happens to you when you are asleep.
The main stay of diagnosis apart from clinical examination is sleep study or polysomnography. It involves placement of special sensors on the skin to monitor the many physical processes as you sleep. These studies can be conducted in a sleep clinic with a sleep technologist in attendance to ensure the best possible recording. They can also be done in patients home.
Other tests like CT scan of parnanasal sinuses, ECG, Chest X ray, ECHO etc are complementing to the above test. Role of dynamic MRI and sleep endoscopy in ascertaining the area of obstruction is very useful especially in surgical candidates.
The most important step in treating Snoring is recognition and appropriate diagnosis. The various modalities of treatment varies as:
Life style modifications like weight reduction, diet control, better fitness regime, avoiding sleeping on back, avoiding smoking and alcohol, sleeping pills and tranquilizers and avoiding heavy meal at night.
Treating allergy by decongests sometimes help.
Surgeries may be required to remove the physical obstruction and includes septoplasty with or without turbinectomy/turbinoplasty, functional endoscopic sinus surgery, tonsillectomy and adenoidectomy (especially in children), uvulopalatopharyngoplasty, somnoplasty , genioglossus and hyoid advancement etc . With the advancement of technology use of instruments like coablator or radio frequency has made the surgery less invasive and painful.
Another alternative mode of treatment in selected cases is CPAP (continuous positive airway pressure). It is a machine which throws air at high pressure which leads to opening of the mechanical blockage. Patient has to wear it every night before sleep. Dental devices are effective in some selected patients.