Sleep Apnea and Snoring

Though most people have heard of sleep apnea, few realize exactly how prevalent it is or how dangerous it is.  This is extremely unfortunate, as many people suffer from health problems that would be eliminated if only their apnea was diagnosed; many others die without ever having any idea that they were living with a nightly time bomb. People who suffer from sleep apnea simply stop breathing every single night, repeatedly. Their throats close while they are sound asleep and the body struggles to survive without air – sometimes for up to a minute before the oxygen level falls to such a precipitous depth that the brain awakens the body and forces it to gasp for air. The sleeper is not aware that they have experienced this suffocation, or that they have been woken up by it. It returns to sleep, having suffered the effect of oxygen deprivation as well as being robbed of restful sleep. The sleeper has no memory or knowledge of the event the next day, though they are likely exhausted and their internal organs suffer as a result of the stress that they have been put through. Statistically speaking it is estimated that nearly 40,000 fatal strokes and cardiac arrests can be attributed to apnea in the United States each year. Remarkably, most people who suffer from apnea do not do so without people realizing that they have a problem, as most of them share a bedroom with a sleep partner who is well aware of their snoring.  Snoring, and particularly loud, disruptive snoring, is an indication that area is being blocked and that we are not breathing well when we sleep. The question is, just how big is the problem and does it rise to the level of sleep apnea? The throat is designed in such a way that the structural difference between light, harmless snoring and snoring that represents a potentially dangerous failure to breathe is almost indistinguishable. A small amount of extra fat, enlarged tonsils, swollen lymph nodes can all lead to dangerous outcomes. As a rule of thumb, if somebody snores particularly loudly they have a much greater likelihood of falling prey to sleep apnea.  In both snoring and sleep apnea the throat’s walls pull together due to suction while breathing in. For those who suffer from sleep apnea, the suction becomes so great that the throat remains closed and no air gets in or out.  The lungs continue to try to breathe, increasing the vacuum effect on the throat and making the entire body work that much harder to try to get the throat to open and allow oxygen back in. This puts a tremendous strain on the heart, as well as the lungs and brain.  The lack of oxygen and build up of carbon dioxide can actually cause brain damage. Once the body gasps and starts to breathe again, the body goes into a stress reaction. The heart beats too fast and the blood pressure rises. This is why so many sleep apnea patients end up dying in the middle of the night from heart attack and stroke. There is another form of disordered breathing that has recently been identified that is not quite as dangerous as sleep apnea but which can also lead to sleep deprivation and stress. This form is called upper airway resistance syndrome. It is characterized by sleep in which breathing does not actually come to a complete stop, but rather that as breathing becomes more and more difficult as the throat begins to close down, the sleeper unknowingly awakens, then goes back to sleep. These patients generally snore, stop snoring to roll over or cough while they are momentarily awake, and then roll over and go back to their snoring. The problem here is twofold: it is arousing the patient and reducing the amount of rest that they are getting, and it is also a likely precursor to true sleep apnea. People who suffer from sleep apnea generally are excessively sleepy during the day as a result of the constant disruptions that they experience during their sleeping hours. Patients who suffer from sleep apnea are generally suffering from such tremendous sleep debt that they are highly likely to fall asleep at nearly any point, including while in the midst of a conversation, a meal or while at the wheel of a vehicle. The problem is made more dangerous by the fact that they are unaware of the reason behind their exhaustion, and in some cases just as they are unaware that they are waking up in the midst of the night, they are also unaware that they are falling asleep in small microsleep sessions during the course of the day. They are unable to concentrate, unable to remember things and are often prone to poor decision-making as a result of impaired thinking caused by their sleep deprivation. Sleep apnea patients are also prone to a number of physical problems, including reflux, headaches, mood swings and high blood pressure. They can even experience impotence and hearing loss. Despite the fact that these are all well-known symptoms of sleep apnea, far too many physicians miss the signals and don’t make the diagnosis, chasing and treating incorrect conditions while a correct diagnosis would lead to immediate and effective relief, and possibly even saving the patient’s life. Unfortunately, the damage that is done to the body as a result of sleep apnea can have a lasting effect. Even when the problem is treated and the apnea goes away, the patients’ bodies have suffered tremendously. Blood vessels and internal organs cannot continually undergo the kind of stress that apnea places on them without being damaged. Sleep researchers and physicians are in agreement that if a patient who is being seen for the treatment of high blood pressure or cardiovascular problems is asked just a few simple questions about whether they are tired during the day and whether they have been told that they snore at night, many lives could be saved. A yes answer to both questions should lead to a mandatory sleep apnea test, even if it is just a rudimentary tape recorder that allows a physician to listen to the patient sleeping. Many lives would likely be saved.