Obstructive sleep apnea is a serious sleep disorder where people stop breathing for 10 seconds or more at a time.
Snoring can be a key sign of obstructive sleep apnea – but at some point in our lives, we all snore. A cold or allergy can block the nasal passages, a few drinks near the bed automatically relax the muscles of the tongue, palate and throat — and before we know it, we’re unconsciously forcing air through our soft tissues, causing vibrations that escape like a snore.
“Snoring can be normal and not something to be worried about,” said sleep specialist Rebecca Robbins, an instructor in the division of sleep medicine at Harvard Medical School.
“When snoring is loud and shrill, or is interrupted by pauses in breathing, that’s when we start to worry,” Robbins said.
It is estimated that at least 25 million Americans and 936 million people worldwide may suffer from obstructive sleep apnea, with many more undiagnosed.
‘It can be very scary’
It’s called “obstructive” sleep apnea because, unlike central sleep apnea — in which the brain occasionally jumps around telling the body to breathe — obstructive sleep apnea is due to a blockage of the airways by weak, heavy soft tissue. or relaxed.
“The individual is making an effort with the belly and chest so that the air can come in and out, but because of the obstruction in the upper airways, the person cannot. Often the person is not aware of this struggle, which can be very frightening to anyone watching,” said sleep specialist Raj Dasgupta, an associate professor of clinical medicine at the University of Southern California’s Keck School of Medicine.
If left untreated, obstructive sleep apnea puts you at high risk for hypertension, heart disease, type 2 diabetes or depression, even early death, according to the American Academy of Sleep Medicine.
How do you know when your snoring has become dangerous to your health? Sleep experts use a sleep questionnaire with an easy-to-follow call sign: STOP BANG.
S stands for snoring
Snoring is a key indicator, so it tops the list of possible warning signs. But this isn’t a plaintive, tearful snore, and it’s certainly not a snore one would call “cute.”
“We’re talking loud, unpleasant snoring, the kind that would drown out conversations or be heard through closed doors,” Dasgupta said.
“Some of the roommates of my obstructive sleep apnea patients describe their roommates’ snoring as hearing a ‘bear dying’ or a scene from ‘Jurassic Park’,” he added.
T means tired
Being very tired during the day is a prime indicator of poor sleep. Combined with snoring, it can be a telltale symptom of sleep apnea.
“Daytime sleepiness is one of the strongest predictors of sleep apnea,” Robbins said.
“Falling asleep anytime—sitting down for a break after lunch, at a movie theater—these are all hallmark symptoms, along with fatigue and snoring,” said Robbins, co-author of Sleep to Success! Everything you need to know about sleep but are too tired to ask.
What means ‘observed’
Many, if not most, people have no idea that they snore at night. Nor do they know that they stop breathing during the night – unless the blockage is so great that they wake up gasping and choking.
“The ‘O’ stands for observed apnea, and that’s actually worse than just snoring,” Dasgupta said. “An apnea means there is no airflow — no air coming in, no air going out. You are not breathing. Observed apnea is really a red flag.”
Bed partners are often the key to identifying obstructive sleep apnea.
“Seeing your partner stop breathing, snoring, coughing or taking a deep breath are signs that snoring may not be normal, and so is something that deserves attention from a sleep specialist,” Robbins said.
P stands for pressure – high pressure
Obstructive sleep apnea can lead to hypertension. Every time a person stops breathing for a few seconds, the body’s sympathetic nervous system kicks in and increases blood pressure. In addition, the body releases stress hormones called catecholamines, which can also increase blood pressure over time.
While having hypertension on its own is not a sign of a sleep disorder, it can be a warning sign when combined with other telltale signs. Fortunately, treatments for obstructive sleep apnea, such as continuous positive airway pressure, or CPAP, have not only been shown to help with sleep apnea, but have also reduced blood pressure.
B stands for BMI
The body mass index (BMI) is a commonly used score to indicate weight levels. To measure BMI, healthcare providers use height and weight data to track changes in weight in relation to height. Your weight is considered normal if your BMI is between 18.5 and 24.9. You are considered overweight when your BMI is between 25 and 29.9 – and a BMI of 30 or more indicates that you are obese.
Obese or extremely obese people — with a BMI of 35 or more — often suffer from obstructive sleep apnea because the extra weight in the mouth, tongue and neck collapses these soft tissues, making it harder to breathe easily without snoring.
“Weight loss can be a big part of a healthcare provider’s recommendation to treat sleep apnea,” Robbins said.
Obstructive sleep apnea has been on the rise around the world as obesity has reached epidemic proportions, but it wasn’t seen as often before the 1970s, she added.
“In sleep medicine, we joke that Humpty Dumpty was one of the first cases of obstructive sleep apnea because he had a big belly and probably extra tissue around his soft palate. He was in danger of falling asleep all the time and falling off the wall,” Robbins said.
“This was a lullaby and, at the time, an anomaly. But now, unfortunately, it is becoming more and more common with the increase in body mass index that we are seeing across the country and the world,” she added.
A is for age
Muscle tone weakens as we age, including in the soft palate and neck. So being over 50 is another potential sign that your snoring could be – or turn into – obstructive sleep apnea.
There’s some good news — studies are starting to find that sleep apnea in the elderly tends to be mild to moderate, with the most severe cases occurring at younger ages.
N is for the neck
Having a large neck circumference, whether due to being overweight or genetics, is also a key indicator of potential obstructive sleep apnea.
“Now you don’t want to be a weirdo and start measuring your loved one’s neck at night,” Dasgupta said. “The general rule of thumb will always be a necklace size greater than 43 centimeters for a man and more than 40.6 centimeters for a woman, which will put you at greater risk for sleep apnea.”
G is for gender
You’re a man? So, unfortunately, this also increases the risk of obstructive sleep apnea. Some of the reasons could be that men tend to have fatter tongues and carry more fat in their upper body than women, especially in the neck. Men also tend to have more “belly fat,” which can make it difficult to breathe in general.
“However, we definitely see a lot more obstructive sleep apnea in women after menopause,” Dasgupta said.
High risk needs assessment
Now it’s time to score your risk. Give yourself one point for each “yes” answer. If you scored between five and eight, you are at high risk for obstructive sleep apnea and should be evaluated by a sleep specialist.
“Sleep tests these days are much easier to get than in previous years when you could only go to a sleep lab,” Dasgupta said. “You don’t have to be stuck in the lab with a bunch of wires on you looking like Frankenstein. You can do a sleep test at home in your own bed, which is nice.”
But don’t ignore your symptoms, as the negative health effects shouldn’t be ignored, says the American Academy of Sleep Medicine: “Like a fire alarm, snoring is a warning of danger that demands your attention.”
If your score is between zero and two, your risk is obviously low, so snoring is probably not a major health concern. A score of three to four puts you at an intermediate risk, but that doesn’t mean you should ignore your symptoms, especially if you share your bed with a loved one, Dasgupta said.
“It’s always good to be a nice person, and if it affects your bed partner, I think it’s worth getting evaluated,” he said. “If your bed partner is woken up several times during the night by your snoring or can’t fall asleep because of your snoring, then that bed partner is going to be sleep deprived, and that’s not good for their health.”
treatments
The treatment of choice for sleep apnea is the use of continuous positive airway pressure, or CPAP. By pushing air into the lungs through a nasal mask, the device helps keep the airway clear at night.
Weight loss can significantly decrease – or even eliminate, obstructive sleep apnea, as the loss of tissue mass in the mouth, tongue and neck relieves pressure in the airways. Doctors may also prescribe an oral appliance designed to widen the airway by moving the tongue or jaw forward.
If anatomical problems, such as nasal polyps, enlarged tonsils or adenoids, or deviated septum, are contributing to apnea, surgery may be recommended.
Mild cases of sleep apnea may respond to “positional therapy,” a fancy way of saying keep people who sleep on their sides rather than their backs during sleep, which can improve airway flow and reduce snoring.
“I’m a big fan of simple, homemade solutions like sewing tennis balls into the back of pajamas to keep people from turning over on their backs,” Dasgupta said.
“You can be even more creative by putting a bra on someone in reverse and then putting tennis balls in,” Robbins suggested.
Source: CNN Brasil
