Snoring and Obstructive Sleep Apnea

An Outreach Project by Christine Kim | Return To Outreach Projects 2010

On family vacations, my sister and I pray that my dad won't snore too loudly, and my mom nudges my dad when he snores.

Though we threaten to take my dad to a hospital if he keeps snoring, our efforts are to no avail. Every year, the snoring grows worse. However, the longer my family delays visiting a sleep clinic, the more my dad's health and the rest of the family's health is in danger. Unfortunately, my dad isn't an oddity. Approximately 50% of all adults snore (with a higher prevalence of snoring in males). In addition, snoring is a precursor to the dangerous sleep apnea, which affects 80 million people (Dement).

Snoring occurs during sleep when individuals are fighting for more oxygen. It usually occurs due to greater breathing airway resistance. Tonsils, fatty tissues, edema (swelling), or a combination of a smaller jaw and larger tongue, can all reduce airway size and increase airway resistance. Since airway size is reduced in these people and a certain amount of air must be inhaled to achieve necessary oxygen levels, the speed of the incoming air must increase. In turn, this increased speed causes throat tissues and membranes, usually the soft palate and uvula, to vibrate (355). The vibration produces the dreaded snoring noise. Snoring tends to grow worse with age, alcohol consumption, sedative drug use, sleep deprivation, and upper respiratory infections such as head colds (Dement).

Though it can simply be an occasional source of nighttime distraction and frustration, snoring is one of the cardinal signs of obstructive sleep apnea. If snoring is loud enough to interrupt a partner's sleep and interrupted by struggles for air, obstructive sleep apnea is usually present. Obstructive sleep apnea is defined by lack of airflow in nose and mouth despite efforts to breathe (335). Diagnosed by machines that monitor airflow, obstructive sleep apnea is ranked in terms of severity, based on the number of sleep apnea episodes per hour. Each sleep apnea episode is defined as a "cessation of airflow lasting more than ten seconds, and usually terminated by an awakening" (335). It occurs during sleep and ends when the person is awakened. Though the number of episodes varies during the night, the minimum number per hour to be diagnosed as obstructive sleep apnea is 5. Because of these constant, brief interruptions of sleep, many interruptions are not recalled. However, these episodes have drastic consequences. Each episode is associated with drops in blood oxygen, which can cause many complications. Almost all patients with obstructive sleep apnea suffer from high blood pressure, cardiac problems, and overall fatigue (Dement).

In addition to the direct consequences of obstructive sleep apnea, individuals can also rack up an enormous sleep debt. Every hour of the night, minutes of sleep are lost. Moreover, because of the constant interruption, it becomes difficult to attain REM, deep sleep. After each arousal, the individual enters NREM sleep, rather than REM sleep (343). As these minutes of lost sleep rack up, sleep debt increases. An enormous sleep debt can cause drowsiness and fatigue, and can only be replenished by gaining more sleep. Even with individuals who snore but don't suffer from obstructive sleep apnea, their sleeping partners can incur a large sleep debt due to the distracting snoring noises.

Thankfully, snoring and obstructive sleep apnea can easily be fixed. One treatment is CPAP, which is a nasal mask that provides continuous positive airway pressure to the nostrils. This way, normal breathing is restored during sleep (348). Though CPAP must be worn every night, machines can adjust the pressure to make sleep comfortable. Other treatments include surgeries, radio frequency reduction of tissue volume, and dental appliances (350-2). All treatments, whether by reducing tissue, or adjusting the jaw to prevent the tongue from falling backwards and blocking the airway, serve to increase the size of the airway and ease the effort to inhale air.

Treating obstructive sleep apnea and reducing snoring, not only improves the snorer's sleep and overall well being, but the well being of sleep partners. With fewer nightly interruptions, affected people's moods will improve, midday drowsiness will disappear, and overall energy will be at a never-before seen high. As for my snoring dad, he doesn't know it yet, but the whole family is taking him on a trip to a sleep clinic to fix his snoring. Alas, the night symphonies created solely with his mouth and nose must come to an end. Maybe, this hospital trip will save him from being constantly fatigued and drowsy. At the very least, the rest of us will be able to enjoy an uninterrupted night's sleep.

Works Cited: Dement, William. "Lecture 17 ­ OSA I: Breathing is Everything!" Psychology 135. Stanford University. Stanford, 17 February 2010 Dement, William. The Stanford Sleep Book. USA. 2002

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