Snoring and Sleep Apnea

Snoring and Sleep Apnea

People snore from time to time, often with colds or congestion. But, if you snore or gasp most or all of the time, it may mean obstructive sleep apnea (OSA). 

What Is Sleep Apnea?

Sleep apnea is a general term that means to stop breathing during sleep. There are different types of sleep apnea - by far the most common, and what this article covers, is obstructive sleep apnea (OSA).

Obstructive sleep apnea (OSA) means there are periods during sleep when breathing briefly stops or slows down, due to a blocked upper airway. 

Open Upper Airway vs. Blocked Upper Airway

How Common Is OSA?

Although the estimate of the number of people with OSA varies, it is likely to be at least 5.0% of the population.

What Are The Risk Factors For OSA?

There are factors that increase the risk of OSA including:

  • Excess weight, especially in the neck and abdomen

  • Older age

  • Male gender

  • Female after menopause

  • Facial or upper airway abnormalities

  • Family history of OSA

There are also some medical conditions that are associated with OSA. They include:  gastroesophageal reflux disease (GERD), diabetes, hypertension, heart disease, stroke, and depression.

What Are The Symptoms of OSA?

The symptoms of OSA may be mild, moderate, or severe and include:

  • Snoring, gasping, choking, snorting, and  interrupted breathing during sleep (often reported by bed partner)

  • Headaches, dry mouth when waking up

  • Sleepiness during the day

  • Insomnia or trouble falling or staying asleep  (especially in women

  • Waking up with the need to urinate

How Is OSA Diagnosed?

Those with OSA, or their sleep partners, may identify symptoms indicating possible sleep apnea. Or, your doctor may check you for sleep apnea when you are being seen for something else. In either case, a sleep specialist and sleep study are recommended

Sleep Studies

Polysomnography (PSG)

PSG is done in a sleep lab with a technician. There is continuous monitoring of breathing, brain waves, heart rate, eye and muscle activity, and etc. PSG  identifies apnea, as well as other sleep disorders. PSG is the gold standard sleep study.

Home Sleep Apnea Tests (HSAT)

Sleep studies may be done at home with portable monitoring devices. There are different types of HSAT, depending on what is monitored. After HSAT, PSG may still be necessary.

What Is The Treatment For OSA?

OSA treatment may be medical or surgical, behavioral, or a combination of both. 

Medical/Surgical Treatment

Positive Airway Pressure (PAP) Therapy

Depending on sleep study results and other factors, positive airway pressure (PAP) therapy  may be recommended for moderate-to-severe OSA. With PAP, air is delivered to maintain an open airway. 

There are different ways that it is administered;  continuous  positive airway pressure (CPAP) and  auto-titrating positive airway pressure (APAP) are the most common methods  for OSA.  Once PAP is started, the person and the device should be checked frequently

Oral Appliances

Custom-made appliances for the mouth may be used to treat mild to moderate OSA. They help to keep the upper airway open by maintaining the position of the jaw or tongue.  Oral appliances are less effective than PAP therapy, but may be preferred by some people.

Upper Airway Surgery

Surgery may be an option when enlarged tonsils or adenoids block the airway.  It may be a second-choice treatment when PAP and oral appliances aren’t effective or well-tolerated.

Behavioral and Other Treatment

We offer behavioral strategies as part of our sleep program. Behavioral changes are an important part of the treatment for OSA.

Behavioral treatments include weight loss, exercise, positional therapy, and avoiding alcohol and sedatives near bedtime. They may be used to treat people with mild OSA. They may also be complementary to medical/surgical treatment for moderate to severe OSA.  

As with medical treatments, OSA outcomes (like improved sleep and less daytime sleepiness) should be checked after starting behavioral therapies.

Weight Loss 

Extra weight is a risk factor for OSA. Weight loss, along with medical therapy,  is recommended  for those with OSA. Losing weight may not cure OSA, but it can lessen the severity and  improve overall health.  Weight loss may be achieved through healthy eating and regular exercise. 

Exercise

Exercise not only helps with weight loss, if needed, it can also improve the severity of OSA symptoms and decrease sleepiness.

Positional Therapy

Back-sleeping may increase episodes of apnea in some people. Side-sleeping is recommended but may be challenging to maintain. Positional therapy, although not usually by itself,  is a strategy to help back sleepers with OSA. There are simple methods, involving tennis balls or pillows. And, there are special devices with alarms or vibrations.

Sleep Hygiene

Sleep hygiene measures help you get quality sleep. Getting enough sleep, 7 to 8 hours each night can improve OSA, while too little sleep may worsen it.  Avoid alcohol, prescription pain and sleep medicines, like sedatives, because they may also worsen OSA

Gastroesophageal Reflux Disease (GERD) Treatment

GERD and OSA have a close relationship. Treating GERD may help to lessen the symptoms and severity of OSA (treating OSA may also lessen GERD symptoms). Treatment may include medicines and dietary and lifestyle changes.

Nasal Dilators (Strips)

Nasal strips may help those with snoring related to congestion or narrowed nasal passages. They may improve sleep quality. And, they may be helpful for some people with OSA

Why Is It Important To Treat OSA?

OSA, if untreated disrupts sleep, but that is not its only effect. It is also associated with serious conditions like heart disease, diabetes, and depression. And, when OSA causes daytime sleepiness,  it increases the risk of injury, for example, from car accidents.

For More Information

American Academy of Family Physicians (2016). Information from Your Family Doctor: How to Recognize OSA and What It Means for Your Health. Retrieved 8-26-2020 from https://www.aafp.org/afp/2016/0901/p355-s1.html.

National Heart, Lung, and Blood Institute (2020). Sleep Apnea. Retrieved 8-26.2020 from https://www.nhlbi.nih.gov/health-topics/sleep-apnea.