Snoring and Sleep Apnea

Snoring and
Sleep Apnea

The Nighttime Chain Saw
Massacre

You can't understand it. You seem to be getting plenty of sleep, but from the minute you rise, you're tired and sluggish. At work, you have trouble concentrating; even the simplest task seems like a major chore. And coming home tonight, you almost veered the car into a telephone pole because your mind was in the twilight zone.

Not only that, but a very worn-out face has been staring back at you from the mirror. Who is this woman with the frazzled, haggard features, the puffy, baggy eyes, the blank, world-weary expression?

Brace yourself. This woman is you.

You've just seen what a person looks like when she hasn't gotten a good night's sleep for many nights. One reason for the sorry state of your slumber may be that you've been snoring up a storm.

Sawing Lumber in Your Slumber

While it's unusual for women to let 'er rip like a Black & Decker chain saw, and those of us who do rarely duplicate the ear-splitting force of a snoring man, that doesn't mean we can't produce our fair share of snorts and wheezes. Five percent of women between the ages of 30 and 35 snore; by age 60, that figure swells to 40 percent.

Doctors say most snoring is harmless. But heavy snoring can alter your physical and mental well-being. Severe nighttime breathing problems have been linked to heart disease and decreased mental acuity and have even been suspected as causes of sudden death while sleeping. And besides, snoring can really sap your youthful glow.

"At a minimum, it seems to take away your vigor," says Richard Millman, M.D., director of the Sleep Disorders Center of Rhode Island Hospital in Providence. "Many people come into our offices with obstructive sleep breathing problems who are in their forties, but they look, feel and act ten years older."

When Your Airway Says No Way

We all know it when we hear it, but what exactly is that cacophony of nasty nighttime noises we call a snore? It's a partial obstruction of breathing that takes place in the airway running from the nose to the voice box.

If the muscles and tissues in this airway are flabby or toneless, they will cave in. "It's like sucking air through a soggy straw," says David N. F. Fairbanks, M.D., clinical professor of otolaryngology at the George Washington University School of Medicine and Health Sciences in Washington, D.C. "When you breathe, the airway narrows and partially collapses. The structures in the airway vibrate against each other."

Snoring usually is not a problem for women unless they are heavy, have low estrogen levels, have had a hysterectomy or have gone through menopause. While the connection between low estrogen levels and snoring is unclear, doctors do know that estrogen stimulates muscles, preventing them from relaxing.

"Sometime in their forties or fifties, women will begin to lose tone and develop fat in the throat area. Their tongues and larynxes and certain tissues may enlarge a bit as well. Eventually, their airways will collapse. Actually, the percentages of men and women who snore are the same by age 60, and snoring is a common occurrence," says Willard Moran, M.D., clinical professor of otolaryngology at the University of Oklahoma College of Medicine in Oklahoma City.

Snoring is three times more common in overweight people than in thin ones. People with short, thick necks may also do more than their share of sawing wood.

Other snore makers include bulky tongue or throat tissue, large tonsils or adenoids, tumors or cysts in the airway, a recessed jaw, an excessively large uvula (the soft lobe that hangs from the roof of the mouth), and obstructed nasal passages and nasal deformities.

Snoring is a progressive disorder. So a snore that's light or occasional now will probably become more intense as time passes.

Apnea: An Exhausting Condition

When the airway is completely blocked, you may actually stop breathing for ten seconds to one minute. This condition is called sleep apnea, and people who have it wake up briefly every time their breathing ceases, which can be hundreds of times a night. Sleep apnea is most common in middle-aged men, but women can suffer from it, too.

"The brain, sensing a lack of oxygen, signals a loud snorting response that restores tone to the airway and restarts the breathing," says A. Jay Block, M.D., professor of medicine and anesthesiology and chief of the Pulmonary Division at the University of Florida College of Medicine in Gainesville.

Much of the time, people with apnea don't even realize they're waking up and falling asleep all through the night. But the process leaves them exhausted.

In addition, the oxygen levels in their blood may plunge well below normal, forcing the heart to pump harder and causing cardiovascular problems such as high blood pressure, irregular heart rhythms, heart failure, heart attack and stroke.

Snore Stoppers

Snoring does not have to be a life sentence. Today, physicians specializing in sleep and breathing disorders can do wonders for cases of snoring and sleep apnea. But even the heaviest of snores may not need a doctor. The following tips may be all you need to quiet the storm once and for all.

Stop smoking. Smoking irritates the tissues of the nasal passages and upper airway, causing them to swell and obstruct airflow, says Dr. Fairbanks. So this gives you another good reason to kick the habit.

Drop some pounds. People who are overweight are more likely to snore, so trim the fat from your body by trimming the fat from your diet. Most doctors and researchers recommend that you limit your fat intake to 25 percent of the total calories in your diet.

Open your nose. People who breathe through their mouths are more likely to snore, says Dr. Block. Sometimes a cure can be as simple as clearing a chronically stuffed nose. Keep your nasal passages open with an over-the-counter nasal spray (such as Afrin) or saline solution--but follow the instructions carefully. Overuse of nasal spray can cause passages to clog even more. Very severe nasal blockages may require allergy treatments or surgery to correct a nasal deformity.

Curb your alcohol. Alcohol is a depressant that affects the central nervous system and causes the throat muscles to become relaxed and floppy, says Dr. Millman. Don't drink alcohol for four hours prior to going to bed.

Stay off pills and medicines. Tranquilizers and sleeping pills also act on the central nervous system to over-relax throat muscles and cause snoring, says Dr. Millman.

Eat light. Don't eat a large meal three hours before retiring, and steer clear of midnight snacks, says Dr. Moran. That's because the process of digestion causes muscles everywhere--including those in your throat--to relax.

Back off. According to Dr. Moran, sleeping on your back increases the likelihood of snoring, because the tongue drops back in the mouth, creating an obstruction. One way to make sure you don't roll over onto your back is to sew a pocket on the back of your pajamas and place a tennis ball inside. The ball will cause such discomfort when you lie on your back that you'll either wake up or unconsciously roll off your back.

Hoist your head and shoulders. Sleeping on an incline helps keep the airway open, says Dr. Millman. But don't prop your head with pillows; this will only kink the airway. Instead, place bricks under the bedposts at the head of the bed to raise it four to five inches.

Whip your snore. Wearing a neck brace or whiplash collar to bed will keep your chin extended, so your throat may stay open, says Dr. Fairbanks. To guard against a stiff neck the next morning, Dr. Fairbanks suggests using a foam collar rather than a plastic one. Foam cushions the neck better and is less restraining. But if you do have some morning kinks, gently stretching your neck muscles, giving yourself a gentle massage or taking a warm shower will help, he says.

Pop in a dental appliance. Many sleep disorder centers and orthodontists provide retaining devices that prevent the tongue from falling back into the throat. Some appliances accomplish this by actually holding the tongue in place; others pull the bottom jaw forward slightly. While these devices sound cumbersome, Dr. Millman says most patients experience little discomfort.