A Lot of Night Music
For: When Sleep Won’t Come, the Whole
Night Through, September 2003
If you have sleep apnea, usually it's your bed partner who tells you, not always in the gentlest terms, that you are sawing logs all night and that sometimes the snoring stops, followed by a gasp, and possibly a choking sound. If you sleep alone, you may not even know that you snore, and you may not recognize other signs of apnea: restless sleep, daytime fatigue, irritability, and headache. People with sleep apnea may be drowsy during the day or fall asleep while driving. Your partner, if you have sleep apnea, will also suffer from insufficient sleep.
Obstructive sleep apnea is caused by a temporary blockage of the breathing passages. (Central sleep apnea, another form, is caused by a brain dysfunction, but the results are the same.) The soft tissues of the mouth vibrate during snoring, but with apnea the tongue and other soft tissues periodically fall back and collapse the airway, sometimes totally, sometimes only partially. In either case breathing stops or becomes very shallow, causing oxygen levels in the blood to fall. Your throat muscles contract as you gasp for air, and breathing starts again. Your bedfellow may wonder if you've stopped breathing altogether.
Sleep apnea has only recently come to be regarded as a serious problem. Women sometimes have it, but it is most common in men and the obese. A man with a neck circumference of 17 inches or larger (for a woman it's 16 inches) is more likely to have an airway collapse while sleeping. Though not everyone who snores has apnea, loud snorers are most likely to have it. Heavy drinking is another risk factor.
Why apnea is bad for you
The interruption of sleep and its daytime consequences—such as drowsiness and slow reaction time when driving—are sufficient reason to seek treatment. And, though not all the experts agree about this, there is also some evidence that apnea increases the risk of hypertension and cardiovascular disease. The connection between sleep apnea and high blood pressure, though extensively studied, remains controversial. Breathing stoppage for short periods during the night can cause a temporary rise in blood pressure that may become chronic, some researchers believe. Others say the evidence for this is not convincing.
Nevertheless, the possible connection between sleep apnea and hypertension is worth keeping in mind. If you are seeing your doctor about sleep apnea or simply because you aren't sleeping well, get your blood pressure checked. This should be routine in any office visit anyway. And if you have been diagnosed with hypertension and/or are overweight—particularly if you know you snore a lot—your doctor should test you for sleep apnea. You may need to see an ear, nose, and throat specialist, who may send you to a sleep clinic at a nearby hospital. Spending the night in such a facility for special testing is the best way to get sleep apnea diagnosed. The procedure is painless—you simply check in and go to sleep.
If you do have the condition, do-it-yourself therapies may be all you need to correct it:
• If you're overweight, even a 10% reduction in your weight should help.
• Cut back on alcohol, and don't drink alcoholic beverages in the evening. Try not to eat heavy meals in the evening.
• If you smoke, stop.
• Elevate the head of your bed—use bricks or fat telephone books under the bed frame.
• Avoid sleeping on your back.
• Try one of the less expensive appliances that reposition the lower jaw as you sleep. A little like the mouthpieces worn by football players, these "mandibular advancement" devices sell for about $50. Sleep clinics and many doctors can advise about these.
If self-help fails
If these measures don't help, your doctor may prescribe CPAP (which stands for "continuous positive airway pressure" and is pronounced "see pap"). This is an air pump attached to a face mask or nasal tube; it maintains a flow of air. You have to sleep with the device in place, and while some people find it cumbersome, you may welcome the relief it provides for you (and other household members). It really does work when used properly. There are also custom-made mandibular advancement devices (a dentist can order them) that pull the tongue and jaw forward while you sleep. They may cost $4,000 and up, and insurance usually does not pay for them. Surgery to widen the airway can also be done, but the benefits are not clear. You should get a second opinion before considering surgery and should try every other option first.
UC Berkeley Wellness Letter, May 2000
