Have you ever wondered why young people in their 30’s and 40’s are getting heart attacks and some sadly are passing away? Snoring and associated obstructive sleep apnea is now emerging as one of the causes.
Snoring which until recently was considered a nuisance to your bed partner is now emerging as a killer. Snoring, the harsh sound produced by air forcing its way through narrow passageways in the throat, causing the relaxed muscle tissue to vibrate.
How can snoring kill you?
There are now multiple studies showing the link between snoring, obstructive sleep apnea and early onset of co-morbidities such as diabetes, hypertension, heart attack, stroke, obesity, daytime sleepiness – causing falling off asleep at driving wheel leading to vehicular accidents.
Snoring is most of the times a symptom of Obstructive sleep apnea, a now emerging dangerous health condition.
Do I have obstructive sleep apnea?
You most likely have obstructive sleep apnea if you are experiencing any of the following
- Your snoring is so loud that it can be heard in the next room
- Your bed partner is noticing that you are suddenly stopping snoring (and breathing) in the midst of your sleep or you are seeing that you are choking for breath in your sleep.
- Lack of freshness in the morning after a regular 7-8 hour sleep
- Sore and dry throat when you wake up in the morning
- Lack of concentration at work
- Dozing off in between meetings or when inactive at work for 5-10 minutes
- Kids respond differently to disturbed sleep because of snoring and sleep apnea by being hyperactive throughout their active hours.
What causes snoring and obstructive sleep apnea?
When you breathe, the air has to pass through many passageways before reaching the lungs.
In order, the air passes through
- From front to back of nose reaching the top of throat
- Through the throat behind the soft palate, the muscular structure at the roof of your mouth
- Through the throat behind the tongue
- Through the throat into the Larynx – the voice box
- Windpipe
During sleep
The throat is surrounded by sheet-like muscles called constrictors and other palatal muscles.
These muscles maintain a particular tone under signalling from the brain when you are awake, keeping the air passageway patent. When you sleep, the brain stops signalling the muscles to maintain tone, and they relax, narrowing air passageway to a certain extent. The following conditions can further narrow down the air passageway, forcing the air through very narrow passageways causing relaxed neck muscle tissue to vibrate causing snoring.
- Nose and sinus conditions such as deviated septum, hypertrophied turbinates, sinusitis, nasal polyposis
- Palatal conditions such as bulky and elongated soft palate (the muscular structure at the roof of your mouth), elongated uvula (the triangular structure hanging from soft palate), enlarged tonsils.
- Fat deposition in the neck circumferentially as seen in obese people
- Bulky tongue and small jaw pushing the tongue back
In obstructive sleep apnea, the obstruction to air passageway becomes so severe, that only very little air is allowed and sometimes no air is allowed to reach the lungs. This causes the oxygen levels in the body to drop to alarming levels, and these low oxygen levels (and high Co2 levels) signal the brain to immediately wake you up so that you can deeply breathe and replenish the oxygen levels in your body. Your brain responding to such an emergency releases certain chemicals such as adrenaline to force-start your breathing, and these chemicals are what is responsible for the early onset and progression of co-morbidities which we spoke about previously.
How can Obstructive sleep apnea (OSA) be diagnosed?
An ENT surgeon following a physical examination of your ENT may request for one or many of the following diagnostic tests. The idea is to recognise the site of blocks in air passageway
- Sleep study
- Dynamic MRI – OSA protocol
- CT of Nose and Sinuses
- Cephalometry
- Sleep endoscopy
How can OSA be treated?
OSA can be treated in a multitude of ways. The following are the options available. Few of them can be used standalone, and few need to combine to get the required results
- Oral appliances
- CPAP
- Upper airway tract surgery
Remember the saying “A stitch in time saves nine”, Don’t merely ignore snoring – make sure you do not have OSA and if you do, it is better to start treatment immediately to let your family members sleep in peace – with you by their side.
