20 June 2010

Snoring, Sleep Apnea, and Happy Father's Day

Men have their struggles and so do women. The guys have historically had it better in the job market, while women live longer. Trade offs are everywhere. One place where men do get the short end of the stick is with snoring and sleep apnea.

I snore and have sleep apnea. It has caused a number of problems in my life. Here's my story, but first some definitions:
Snoring - making excessive noise while asleep during breathing. It can emanate from the nose or throat and is caused by partial obstruction in the air passages.
Sleep apnea or obstructive sleep apnea - obstruction during inhalation while sleeping. The word is from the Greek roots a: wihout, and pnea: air (same root as pneumatic and pneumonia).

I have a history of snoring dating back about 12 - 15 years. I probably snored some before that, but more sporadically. Over the years, my snoring got worse and worse. I slept on my side, face, changed position, etc. All those measures helped--for a while.

I began to sleep really hot. I would wake up and my sheets or nightshirts and pillow would be drenched in sweat. I became a serious head sweater. I did not link it to any underlying problem. It was just some weird sweating thing I did.

Finally, my wife had enough of the snoring and I went to see an otolarygologist. He told me I had three things going against me: I'm male, I'm not young anymore, and I could stand to lose a few pounds. I also got a sleep study. That is where they hook up sensors that measure heart rate, respiration, and other functions. They told me I had mild sporadic sleep apnea. Since there was nothing I could do about maleness or age, I embarked on a weight loss approach by reducing fat, exercising, etc.

I really tried, but just could not lose the weight. In fact I gained. Somewhere around his time we moved to California. My weight continued to climb, my blood pressure increased, I would feel a need to doze in the afternoons, and driving lfor more than an hour or so could be a real problem for me because I would get very sleepy. I had a persistent headache. Not bad, but it would not go away.

I got another sleep test, but this time the apnea was worse. The doctor strongly recommended that I use a CPAP (Continuous Positive Airway Pressure) machine.

It changed my life. The headaches went away immediately. I woke up with a dry pillow. I had less drowsiness problems during the day. Unfortunately, the noise from the machine and air leaking, etc bothered my wife almost as much as the snoring, so the noise has continued to be a problem in our lives. We do not sleep together as much as either of us would like. I am still working on my weight and have made good progress. I have found that when I get my weight below 200 lbs, snoring and apnea are hardly a problem.

I have gotten several consultations and found that in my case, because of the configuration of my tongue and throat, I would need fairly major surgery to fix it. There is a fairly low percentage of success, and if it fails, the CPAP machine would no longer be effective. So my best choice is to continue with the CPAP and lose weight in order to get it out of the bedroom.

Why Care?
I think of snoring as pre-apnea. If you snore you may not have sleep apena, but if you have sleep apena you probably snore. Snoring by itself is not a health risk. Only when it continues to sleep apnea does it cause severe health problems.

The sleep apnea cycle looks something like this:
1. You begin to fall asleep
2. Your throat muscles relax, closing the airway in the throat
3. Breathing stops
4. You wake up because you are suffocating

This causes hormonal changes (including excessive cortisol) and bad sleep patterns. Which lead to all sorts of problems.

Some common symptoms of sleep apnea include:
  • Restless sleep
  • Excessive sweating at night
  • Loud, heavy snoring often interrupted by silence and gasps
  • Drowsiness or lack of energy, caused by the lack of sleep
  • Headaches in the morning
  • Irritability, forgetfulness, mood or behavior changes
  • Anxiety or depression
  • Sore throat in the morning

It is believed that sleep apnea leads to other problems including:
  • Causes bodily changes that lead to Hypertension or high blood pressure
  • Heart related conditions such as coronary artery disease, myocardial infarction and stroke
  • Psychiatric problems such as depression
  • Impotence and lack of interest in sex
  • Cognitive dysfunction or memory loss

E4E Recommendations:
  1. If you have any of the symptoms or if people tell you that you snore or hold your breath while sleeping, get a sleep study done.
  2. Limit alcohol. It can have a relaxing effect on those throat muscles.
  3. Do not sleep on your back.
  4. Get a CPAP as a first line treatment. Breaking the cycle of bad sleep can help you ultimately make the lifestyle changes required to go off the machine eventually.
  5. Focus on eating well to get your weight under control.
  6. Consider other treatments for apnea. There are dental appliances that reposition your jaw at night, and a wide range of surgeries from minimally invasive to major jaw reconstructions. These surgeries can also work for simple snoring, but you have to question whether the cure is more dangerous than the condition at that point. Also, when snoring is caused by nasal obstructions (e.g. deviated septum), it can sometimes be fixed with surgery.
  7. Since this is mainly a male disorder, I want to encourage partners of men with sleep disorders to encourage them to do the above. It could be the best Father's Day present they'll ever get.
  8. Also for partners of snorers, if the noise is a problem with or without treatment, try earplugs or a white noise machine. Sleeping together is a good form of physical intimacy.

Happy Father's Day
Take care.

Additional links:

A fantastic site from UCSF Sleep Surgery Center with full information and treatment alternatives. The focus is on surgery, but the overview page is excellent.

An online test from UCSF
An online test you can take.