Snoring can signal serious issues

Although people joke about snoring, doctors are less inclined these days to make light of loud Z’s.

The reason: What keeps your spouse awake might signal more serious health issues.

Snoring should get checked if it gets louder and has symptoms such as gasps for air or interrupted breathing. Health experts are less concerned about what’s called primary snoring as a steady rhythmic sound that might get you elbowed to move.

“There are basically two types of snores,” said David Swanson, supervisor at Providence Holy Family Hospital’s sleep clinic and a respiratory therapist. “One is just a rhythmic type of snore, and usually the volume level stays about the same.”

With that, you typically won’t snore, or the sound softens if you move from your back to side.

“The other type of snoring, which about 75% of people who snore will have, is obstructive sleep apnea along with that snore. That’s more like a crescendo-type snore where the volume gets louder and louder, then all of the sudden you don’t hear anything for a while because the airway is closed.”

That scenario sounds like a loud snort. Nearly 30 million U.S. residents have obstructive sleep apnea that involves repeated collapse of the upper airway during sleep. Warning signs include that crescendo snoring and excessive daytime sleepiness.

“It’s important to keep track of symptoms in addition to the snoring,” said Dr. Michael Cruz, with Spokane Ear, Nose and Throat and an ENT physician. “Do you wake up gasping? Are you getting restorative sleep?”

Interrupted breathing could last 10 seconds or longer, Cruz added. Is sleep beneficial, or are you chronically tired and take daytime naps? Can somebody watch for irregular breathing patterns during sleep? Does it look like you’re struggling to breathe? How you answer could determine whether you need to seek medical help.

“That would be time to send them to a sleep doctor or sleep lab,” Cruz said.

Discuss snoring concerns with a primary care physician, who might refer you to a sleep doctor. A specialist or primary doctor will likely call for a sleep test. Many patients now do those overnight in the home with a portable device.

Obstructive sleep apnea, which can reduce the amount of oxygen the brain gets, may be a risk factor for stroke along with other concerns.

“With OSA there’s increased risk of heart disease, stroke, diabetes, and you’ll gain weight a lot easier,” Swanson said. “You’ll get up and go to the bathroom more often at night because the drop in oxygen level can actually affect the kidneys. There’s poor memory, difficulty concentrating.

“Another reason a person should go talk to a doctor is if they have other co-morbidity issues such as heart problems, atrial fibrillation and extreme obesity.”

Why do you snore?

“Snoring in simplest terms is vibration of tissue,” Cruz said. “The most obvious tissue that would vibrate when somebody is snoring is the uvula, or the back of the palette that hangs down.”

Insurance companies don’t recognize primary snoring during restful sleep as a medical condition. “They’ll often describe that snoring as a social nuisance but not a medical condition.”

During sleep, throat muscles relax. Sometimes the tongue falls back in the mouth and partially blocks. The greater the obstruction in the airway, the louder snoring gets.

Bigger health concerns involve severe snoring and when the airway collapses, causing obstruction of airflow, said Dr. Gregory Belenky, professor with the Sleep and Performance Research Center in the Elson S. Floyd College of Medicine.

“You worry about snoring if it’s not just snoring, but it’s clear the snoring becomes severe, the airway collapses and there’s obstruction of airflow,” Belenky said.

“There are lots of nerve endings in the upper airway, and it is very sensitive to blocking. When it gets blocked, it screams bloody murder.” People then wake up just enough to start breathing again.

However, people with sleep apnea typically don’t wake to consciousness and are often unaware of it. Muscle tone is key, another reason why aging is a factor in snoring more. Taking a muscle relaxant can contribute, as can drinking alcohol before sleep.

Obesity also contributes because the body has to work harder at breathing in sleep. Another factor might be that the nose is obstructed. “So in some patients you can eliminate nasal obstruction,” Cruz said. People then can breathe through the nose at night and don’t snore as much.

Tonsils also could be issue. It’s less frequent, but children can have snoring and sleep apnea, Swanson added. It’s sometimes misdiagnosed as attention deficit hyperactivity disorder because of lingering sleep and breathing problems. Those kids are often helped when tonsils are removed, he added.

“There are a lot of contributing factors to snoring,” Cruz said. “It’s mostly related to muscle tone, so patients who are really fatigued will often snore more than patients who aren’t.”

Treatments

Positive airway pressure therapy, with a PAP device, is a common treatment for sleep apnea. The term CPAP, for continuous positive airway pressure, is becoming outdated, Swanson said.

Doctors now can set a range of pressure, and the device detects when a patient needs a higher level. “(Continuous) is an old term because that’s rarely used anymore. The machine is smart enough to know when the patient needs a higher pressure, like if they’re on their back or in REM sleep.”

PAP masks of the past were bulky. Today’s models are smaller and fit more comfortably, he said. However, some patients turn to dental appliances.

Dr. Robb Heinrich, a Spokane dentist, also offers sleep dentistry providing oral appliances used for sleep apnea or primary snoring. The device, worn similarly to an orthodontic retainer, is made from sturdier material and pushes out the lower jaw to help open the airway.

Patients can select from five oral appliances, while ones for sleep apnea tend to be more durable with design differences. Most medical insurance companies will cover an appliance if it’s for diagnosed sleep apnea, he said.

“By moving the lower jaw forward and opening up the jaw a little bit, it makes more room for the tongue,” Heinrich said. “Since the tongue is attached to the floor of the mouth, by bringing the lower jaw forward, that tongue comes forward.”

The appliance also helps to stabilize the airway where soft tissues in the back of the throat collapse, he said. “The third thing it does over time, to a certain extent, is it helps strengthen muscles around the airway, which in turn helps to keep the airway from collapsing.”

But Heinrich adds that PAP therapy is still considered a gold standard for sleep apnea. If you have basic snoring, doctors suggest avoiding alcohol and muscle relaxants before bedtime, keeping weight down and sleeping on your side.

“But for some patients it could be a Breathe Right strip on the nose, so they can breathe better through the nose when they sleep,” Cruz said.