Sleep Disordered Breathing - Snoring and Sleep Apnea

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Loud snoring, although seemingly an amusing complaint by a spouse or bed partner, can be one of life’s great frustrations when it interferes with one’s ability to get a normal night’s sleep yourself. It can be a source of great tension or friction in relationships. Indeed, it is said that the western outlaw, John Wesley Harding, was so disturbed by the loud snoring of a hotel guest in the room next to his that he shot him dead through the wall. Anybody can produce loud snoring. A survey of White House employees suggested that at least 40% of all American presidents suffered from loud snoring. The distinction for the loudest snoring by a president is reported to belong to Teddy Roosevelt. Even certain breeds of dogs can experience loud snoring. It is most common among short-necked varieties like bull dogs.

Snoring is the noise produced by the vibration and flutter of soft tissue in the upper throat. Most often, the uvula hanging down and the back end of the soft palate to which it is attached are blamed for producing this noise. The back of the tongue can also contribute. These soft tissues are within the flow of air during breathing and, under certain circumstances, they can also collapse inward producing a partial or total blockage to breathing. When blockages occur with significant frequency, sleep is disturbed and the patient often reports sleepiness or fatigue throughout the following day.

Snoring can also be a symptom of a potential health problem, known as obstructive sleep apnea syndrome. Sleep apnea syndrome is defined as complete blockages (known as apneas) occurring at least five times an hour or partial blockages (known as hypopneas) occurring at least ten times per hour over a course of a night’s sleep. These blockages can also result in health consequences. When the breathing is obstructed, the amount of oxygen in the blood falls which can, over time, cause high blood pressure, heart failure and heart rhythm abnormalities.

There are a number of predisposing factors to snoring with or without associated sleep apnea syndrome. It is more common in men than women, it is more common in people who are overweight than in people who are thin, it is more common in older than in younger people, and it is more common in people who use drugs or medications which result in sedation, including alcohol, sedatives, and antihistamines.

The first step in the evaluation of a person with a snoring complaint is to take a complete history and to perform a complete examination of the upper respiratory tract. This usually includes an examination of the voice box and lower throat known as a flexible fiberoptic examination. The purpose of the examination is to look for any normal or abnormal structures in the upper airway which can interfere with the normal flow of air during breathing. Some of the potential contributing factors to snoring and sleep apnea include enlargement of the uvula, elongation of the soft palate, tonsil enlargement, nasal obstruction, or tongue enlargement. Nasal obstruction can result from a great many abnormalities including deviation of the nasal septum, nasal polyps, and allergies.

If the history and physical examination are suggestive of sleep apnea, the next step in the evaluation is to have the patient undergo a test known as a polysomnogram. This is also known as a sleep study and it is an overnight test where measurements of breathing and other body functions during sleep are made to determine if the problem is simple snoring or the more serious obstructive sleep apnea syndrome.

There are a variety of surgical and non-surgical forms of treatment for snoring and sleep apnea. For some patients, weight loss and treatment for nasal obstruction are the only treatments needed to solve the problem. For others, certain kinds of devices can be used to either hold the mouth a bit open during sleep or to pump air through the nose during sleep. Surgical treatments are usually oriented toward removal of excess tissue in the upper throat or correction of nasal blockage.

For more information, contact Dr. Kelvin Lee or Dr. Kenneth Schneider.