DO YOU SNORE?

Sleep apnea is a common and serious sleep disorder. People with sleep apnea stop breathing or have only very shallow breaths for 15-30 seconds up to 30 times an hour. Obstructive sleep apnea (OSA) is the most common form of sleep apnea. In OSA, a person tries to take a normal deep breath but the trachea or windpipe is blocked or obstructed – perhaps by the tongue, the tonsils, the uvula, or a large amount of fatty tissue. Central sleep apnea is much less common and will not be discussed in this article.

In one study, as many as 9.1 percent of men and 4.0 percent of women had significant OSA. The risk is increased in people who are snore loudly, have high blood pressure, have decreased size of their airways (nose, throat, or mouth), or have a family history of OSA. More than half the people with OSA are overweight.

The most common signs of OSA are snoring and long pauses in breathing while you sleep. You may wake up choking or gasping for breath. You may not notice any of these signs yourself but the person you sleep with may bring them to your attention. You may also experience daytime sleepiness and may have trouble staying awake at work or while driving. Other common symptoms include irritability, morning headaches, mood swings or depression, and poor concentration.

While snoring can be disruptive to your spouse or partner, OSA can have more dangerous consequences. People with OSA have an increased risk of heart attack, stroke, high blood pressure, and irregular heart beat. Almost half the people with OSA have hypertension and the more severe the OSA, the more likely a person is to have high blood pressure. Proper diagnosis and treatment can often reduce or resolve some of these conditions.

If you (or your partner) think you may have OSA, visit your doctor. He or she will conduct a history and physical exam to assess your risk factors. The next step is usually to send you to a sleep disorder center for a sleep study or nocturnal polysomnography. You will be hooked up to various devices to monitor your heart and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels. You will sleep overnight at the sleep disorder center and return to home in the morning. By monitoring all of these functions for an extended period, a doctor who specializes in sleep disorders can determine whether you have sleep apnea or another sleep disorder like narcolepsy.

For mild cases of OSA, lifestyle changes may be enough to resolve your symptoms. If you are overweight, your doctor will recommend that you lose weight. Alcohol and certain other drugs depress the central nervous system, relax the muscles in the back of your throat, and worsen OSA. The daytime sleepiness associated with OSA can be dangerous and your doctor will warn you about the risks of driving or operating heavy equipment. Sometimes people with OSA find that symptoms are better controlled by sleeping on the side instead of the back. There are drugs available to treat OSA but they have many side effects, are not necessarily effective, and are rarely used.

The most common treatment for OSA is the use of a continuous positive airway pressure (CPAP) device. A CPAP machine has a mask that fits over your nose and mouth while you are sleeping. Pressurized air is pumped into your nose and mouth and keeps open the tissues that are blocking your trachea or windpipe. The CPAP mask must be fitted to you individually and the pressure settings must be customized to your needs. Although many people feel significantly better as soon as they start to use the CPAP machine, a number of people are unable to tolerate it or can only use it for a few hours a night.

Other treatments such as appliances that fit into the mouth or surgery are also available but are typically used only in patients who are not helped by CPAP.

Dr. McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny County and Pennsylvania Medical Societies. She is in solo practice in the North Hills of Pittsburgh.