Snoring is a social and medical problem that affects both men and women. It is surprisingly common yet under- diagnosed and under – evaluated. Besides the physical dangers posed by snoring, as explained further in the article, it also causes an immense amount of stress and tension amongst spouses and in relationships!
My spouse snores. Is this dangerous?
Snoring on its own is not necessarily dangerous. Snoring is simply the sound that you make during breathing while asleep. This is due to any obstruction in your airway. While it may be disturbing and unpleasant for your partner, snoring is not in itself harmful. If however, you stop breathing while snoring, this is a sign that there may be something serious going on. This is called sleep apnoea.
If you snore, you don’t always have sleep apnoea and you don’t have to snore to have sleep apnoea.
What is sleep apnoea?
As described above, sleep apnoea is when we stop breathing during sleep. The type of sleep apnoea caused by airway blockage is called obstructive sleep apnoea and is the type we will be discussing in this article.
Why is sleep apnoea serious?
If you stop breathing, the oxygen levels in the blood fall and the carbon dioxide goes up. This sets in motion physiological changes in your body that puts strain on your heart and lungs. The long term effect results in hypertension and eventually heart failure. The effect of low oxygen and high carbon dioxide on the brain results in poor concentration and sleepiness. Thus the condition impacts greatly on your quality of life.
What are the effects on my health?
The effects of snoring on your health are mostly due to sleep deprivation and oxygen deprivation.
Sleep deprivation is caused by frequent waking, whether you remember it or not. (Even the sleep partner may lose up to an hour of sleep per night). The person with sleep apnoea will wake up not feeling rested and have difficulty staying awake during the day. The effects of sleep deprivation include a compromised immune system, irritability, poor mental function and depression.
The oxygen deprivation results in cardio-respiratory strain resulting in heart disease, high blood pressure, sexual dysfunction and memory problems.
What causes the airway blockage?
The blockage is never due to one thing only. It’s usually a combination of narrowing of the airway in multiple places from the tip of the nose to the entrance of the lungs.
Common causes and risks are:
- Being overweight (although more than 1/3 of people with sleep apnoea are not obese)
- Large tonsils, adenoids, palate or tongue
- Nose: deviated septum or blockage (from cold, sinusitis, allergies, smoking, etc.)
- Shape of cheeks (small maxilla) and chin (receding)
- Neck or collar size more than 43 inches.
- Position during sleep
- Throat muscles and tongue becoming more lax (caused by alcohol, sedatives, tiredness or age).
How do I know if I have sleep apnoea?
If you are likely to dose off (due to excessive tiredness) in more than 4 out of the 8 situations below, you may have sleep apnoea:
- 1. Sitting and reading
- 2. Watching TV
- 3. Sitting inactive in a public place (e.g a movie or a meeting)
- 4. As a passenger in a car for an hour without a break
- 5. Lying down in the afternoon
- 6. Sitting and talking to someone
- 7. Sitting quietly after a lunch
- 8. In a car, while stopped for a few minutes in traffic
How is sleep apnoea diagnosed?You have to have a physical examination by a specialist and have to undergo a sleep study. During the sleep study, which is conducted in a sleep centre, the technician monitors various physiological parameters while you are sleeping. These include oxygen levels in the blood, breathing and heart rate. The measurements are interpreted and a sleep score is tabulated. This score places the sleep apnoea sufferer into mild, moderate and severe categories.Record yourself sleeping – Your spouse can record your snoring using a mobile phone. This can be a helpful tool for your doctor. What can I do to help myself?Most importantly, if you suspect sleep apnoea, PLEASE seek a specialist opinion. However, mild sleep apnoea can be helped by: 1. Lose weight.Losing even 10% of your weight can reduce sleep apnoea and improve sleep quality. Aim for a body mass index (BMI) of less than 25.
- Avoid Alcohol, tobacco, and sedatives.
- Sleep on your side. Use special pillows.
- Elevate the head of your bed 10cm from the legs. This can alleviate snoring and reflux.
- Maintain regular sleep hours and good sleep hygiene.
- Use a nasal dilator or nasal sprays to help open nasal passages.
What are my treatment options?
There are broadly four options.
- 1. Lose weight – This is a given
- 2. Using an airway appliance: They open your airway by bringing your lower jaw or your tongue forward during sleep. Most fit inside your mouth and resemble a mouth guard or orthodontic appliance. Others fit around your head and chin. Oral devices are less cumbersome than CPAP (see below) and relatively simple to use. They are only effective for mild to moderate sleep apnoea.
- 3. Continuous positive airway pressure – CPAP is the most widely recommended treatment for moderate to severe obstructive sleep apnoea. CPAP requires wearing a mask while you sleep, which provides pressurized air to prevent the airway from collapsing.
- 4. Surgery. Surgery can increase the size of your airway. The ENT may remove tonsils, adenoids, or excess tissue at the back of the throat or inside the nose.
As with every medical case, there’s always an easy or a more difficult route to follow to solve the problem. The more tedious route would involve seeing your doctor and actively work at solving the underlying problem, such as losing weight, medication, dietary changes etc
The easy way would be to gift your spouse with a good pair of earplugs J (this is however not the recommended route of management)