Snoring Can Be A Silient Killer!

Snoring is definitely a nuisance, usually not to the person who snores but to their partner, or anyone else who's unlucky enough to be in the immediate vicinity. If snorers’ spouses do not complain about the noise the snoring causes, or they simply get used to it, then the snorers will not feel like anything is wrong. They may, in fact, have no idea that they even snore in the first place!

After all, they cannot hear the "beautiful music" they "compose and play" nearly every time they go to sleep. Only when the sleep quality of their spouses has been adversely affected or they themselves find that they are excessively tired during the day even after sufficient hours of sleep, they will then start realizing that they should do something about the problem of snoring.

So what causes people to snore?

Snoring is a signal that indicates the possibility of a sleep disorder known as sleep apnea (apnoea in UK English). An apnea is defined as a cessation of breathing for at least 10 seconds.

There are generally two groups of patients. Simple snorers are those who snore without excessive daytime tiredness. The other group consists of patients with obstructive sleep apnea (OSA), who snore and have pauses in breathing during sleep with excessive daytime sleepiness. OSA refers to a condition characterized by recurrent apneas due to upper airway obstruction during sleep.

The upper airway (air passage behind the tongue) collapses due to excessive relaxation of the upper airway muscles, which occurs during sleep. This will in turn lead to a temporary interruption of breathing, causing a fall in oxygenation of blood. The snorer will struggle to breathe until these efforts arouse his or her brain and breathing — then he or she will resume breathing with a few loud snorts. The whole process can be repeated hundreds of times a night that cause disruption in both breathing and sleep resulting in so called “sleep fragmentation”, which causes snorers to feel extremely tire during the daytime.

Sleep apnea is usually associated with obese men and women. These people have thicker necks, which is due to fat deposits and this additional weight often further narrows the upper airway and aggravates obstructive apneas. Obese males tend to have a higher chance of sleep apnea than obese females. This may be because of the different pattern of fat disposition between male and female patients. An obese male will tend to have more fat tissues in the neck and upper torso (“apple shape”), while an obese female is typically more endowed in the lower half (“pear shape”).

Sleep fragmentation will make sleep apnea patients experience increased daytime sleepiness. Patients will fall asleep inappropriately while driving, reading and in severe cases even during conversation. Research has shown that sleep apnea patients are 4 to 5 times more prone to having road accidents compared to the general population. This will affect work performance and increase workplace accidents in cases where patients operate heavy machinery.

OSA can also have profound effects on the cardio-respiratory systems. The blood pressure tends to rise during this period accompanied by changes in the heart rate and rhythm. The Sleep and Heart Health Study and the Wisconsin Sleep Cohort have demonstrated a strong link between OSA and hypertension.  Patients with OSA will have a higher chance (1.6 to 2.3 times) of a heart attack and stroke than normal patients. In addition, symptoms like early morning headache, irritability, short-term memory loss and even impotency can also be experienced in some patients.

Snoring patients with a history of excessive tiredness, especially those with a history of hypertension, heart disease, and strokes, should seek diagnosis with the help of polysomnogram or sleep test. This involves setting up various small sensors on the body to monitor and record the breathing and sleep parameters during sleep.

For people with simple snoring and mild OSA, simple procedure such as synthetic Palatal Pillar Implants can be used as a treatment. It is an office-based, day procedure and can be done within 10 minutes under local anesthesia with minimal pain and short recovery time. The results are said to be very impressing and encouraging.

Conservative therapy includes reducing alcohol intake, avoiding sedatives, decreasing smoking, sleeping on one’s side, regular exercise, and reducing weight if the patient is obese. It has been shown that mild to moderate weight loss of 10 percent may lead to significant improvement in the severity of sleep apnea. The most effective and frequently used treatment for OSA is by Continuous Positive Airway Pressure (CPAP). It requires the patient to wear a nasal mask that is connected to a machine that supplies continuous positive airway pressure throughout the night. The issue of compliance is a major problem. But, if used correctly, it can relieve the apnea and all the symptoms and normalize the risks of developing cardiovascular complications. Another non-invasive method is to use Oral Appliances (OA), which are mouthpieces that are worn while sleeping to prevent the airway from collapsing. It works by repositioning the tongue or mandible forward.

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Surgical treatment can also be used to correct OSA. It ranges from reduction of soft tissues in the mouth to the enlargement of the skeletal framework of the jaw. The traditional uvulopalatopharyngoplasty (UPPP) operation has always been used with other procedures for patients with moderate to severe OSA.

Obstructive sleep apnea is a common sleep disorder. Studies have found that 24 percent of males and 9 percent of female have such disorder. However, it is estimated that about 82 percent of males and 93 percent of females with moderate to severe OSA do not seek diagnosis. Based on the severe consequences that may possibly bring to snorers, it is inevitable that snorers, especially those with extensive daytime tiredness and with history of hypertension or heart disease, should seek diagnosis and treatment if necessary.