Snoring or sleep apnea

What is snoring?

Snoring is the uncontrollable hoarse sound you make from your nose or mouth while sleeping. Typically snoring happens because there is an obstruction in the breathing.

What is sleep apnea?

Sleep apnea is a sleep disorder wherein the breathing starts and stops sporadically while sleeping. There are three types of sleep apnea:

1. Obstructive sleep apnea (OSA): happens when the upper airway is blocked either partially or entirely. OSA is more common among people.

2. Central sleep apnea: is a result of your brain not getting the proper signals to control breathing.

Sleep apnea is one of the very common sleep disorders as studies has shown that it affects 2% to 4% people at least once in their life time.

Middle aged men are more prone to being affected by it.

Is snoring and sleep apnea the same?

No, even though generally snoring and sleep are used interchangeably, they are not the same. However, snoring is a symptom of

Obstructive Sleep Apnea. On the flip side a person who snores doesn’t necessarily have sleep apnea

Note: generally, people who don’t suffer from obstructive sleep apnea but still snore are referred to as simple snorers or primary snorers.

How to differentiate the symptoms of snoring and sleep apnea?

An understanding of a comparative analysis of the symptoms of simple snoring and sleep apnea may help you and your health care provider in making the right diagnosis

Why are you snoring?

Typically snoring is caused when there is an obstruction in the movement of the inhaled air. This obstruction causes turbulence and causes platovular vibrations. Blockages generally cause difficulties in the airflow in the airways. The blockages are generally caused by:

• Air wall swelling – this is caused commonly by:

o Allergy

o Gastroesophageal reflux disease (GERD)– In this disease, the stomach acid often flows back into the tube which connects the stomach and the mouth

• Adenoid tissue hypertrophy

• Deformations

• Disorders within the osseous membrane or the muscular structure

• Adipose tissue pressure on the throat – This is generally caused by obesity when your Body Mass Index is greater than 27

• Endocrinological diseases- these include:

o Acromegaly – in this disease the pituitary gland produces more than the optimal amount of growth hormone

o hypothyroidism – in this disease your thyroid gland produces less than the optimal amount of certain crucial hormones

What causes sleep apnea?

The sporadic collapse of the tissue present in the rear end of the throat while sleeping causes Obstructive Sleep Apnea. As the tissue collapses, it leads to the blockage of the airway.

Central sleep apnea is caused by a symptom of the central nervous system dysfunction. Such dysfunctions include:

• ALS

• Lou Gehrig’s disease

Central sleep apnea is also common in people suffering from heart, lungs, or kidney disease.

What is the best doctor to see for snoring and sleep apnea?

If snoring is impacting the quality of your life and sleep, you can consult an ENT specialist (Otolaryngologists)

If you are experiencing the symptoms of sleep apnea, you would need to consult the following specialists based on the nature of your symptoms:

• Pulmonologist

• ENT specialist (Otolaryngologist)

• Primary care provider

• Respiratory therapist

How is sleep apnea diagnosed?

To diagnose sleep apnea, your doctor may recommend sleep evaluation in the presence of a sleep specialist. This can be done in two ways:

• Overnight sleep study Polysomnogram (PSG): An overnight sleep study done in a laboratory. In it while you sleep following is recorded:

o Brain’s electrical activity

o Muscle activity

o Eye movements

o Breathing rhythms and patterns

o Heart rate

o Oxygen levels in the blood

Once the study is completed the total number of times your breathing got impaired while you were sleeping is used to find out the intensity of your sleep apnea

• Home sleep test (HST): This test can be done from home; however, it records fewer parameters than PSG. The things that are recorded in PSG include:

o Airflow

o Breathing effort

o Oxygen levels in the blood

This test is conducted to diagnose moderate to severe cases of sleep apnea. However, HST is not the recommended diagnostic test for people without symptoms or the ones who have serious medical problems like a neuromuscular disease.

• If you have the problem of snoring to identify the underlying cause your doctor may ask about:

o Volume and

o Frequency of storing

How to treat and manage Sleep Apnea and snoring?

The treatment of sleep apnea is dependent on the severity of your symptoms.

Mild sleep apnea:

• Conservative therapy: these include:

o Loss of weight

o Avoid regular alcohol consumption

o Working on your position during sleeping

o Nasal sprays

• Mechanical therapy: In Mechanical therapy, your doctor may recommend Positive Airway Therapy (PAP) therapy. This is the first treatment that is prescribed in cases of mild obstructive sleep apnea. In PAP therapy, an air blower is used to force air in your mouth and nose so that there is no closure while sleeping. The different types of PAP devices include:

o Bi-Level PAP– the pressure of flow during inhalation is higher than the pressure during exhalation

o Auto Bi-level PAP – a varying range of pressure that self regulates

o CPAP (continuous positive airway pressure)– use single pressure of airflow

o Adaptive servo-ventilation (ASV)– recommended if the person is suffering from central sleep apnea

Mild to moderate obstructive sleep apnea

• Mandibular advancement devices: These stop the tongue from blocking the throat and keep the jaws forward, thereby keeping the airway open.

• Hypoglossal nerve simulator: a simulator is implanted under the skin (on right side of the chest). Its electrodes are connected to the hypoglossal nerve. When you take a breath, the hypoglossal nerve is stimulated, and the tongue moves forward out of the way to keep the airway open.

In some cases of sleep, apnea surgery may also be required:

• Somnoplasty– surgical treatment for snoring. In this surgery, heat is used to modify your uvula and soft palate tissues

• Mandibular/maxillary advancement surgery– In this surgery, the jawbones forward to expand the airway

• Tonsillectomy- In this surgery, the tonsil is removed

• Nasal surgery– There are many different types of nasal surgery; however, for sleep apnea, your health care provider may recommend the following two:

o Septoplasty: this is performed on the septum, which is the wall separating the left and the right airways of the nasal cavity.

o Turbinate reduction: In this surgery, a needle-like instrument is put inside the turbinate. A short spur of energy is then transferred to the nasal cavity, which damages the turbinate. After the healing is completed, the turbinates will have a reduced size, and there will be an improved space of airflow

Note: turbinates are structures on the side of your nasal cavity

• Uvulopalatopharyngoplasty (UPPP)- the purpose of this surgery is to expand the size of the airway and to reduce the tissue collapse. In this surgery, the excess tissue in the throat is removed to expand the airway

What are the home remedy is right for snoring and obstructive sleep apnea?

The following steps can significantly decrease the amount of snoring:

• Lose weight

• Avoid sleep deprivation

• Avoid sleeping on the back

• Treat nasal congestion

• Don’t over drink before sleeping

• Avoid smoking

Can you permanently treat sleep apnea and snoring?

Yes, the mild to moderate cases of sleep apnea can be cured with the proper treatment and management.

Reference:

1. https://www.ncbi.nlm.nih.gov/-pmc/articles/PMC5789079/
2. https://www.ncbi.nlm.nih.gov/-pmc/articles/PMC5731026/
3. https://www.ncbi.nlm.nih.gov/-pmc/articles/PMC4549693/