Snoring may not just be an aural irritant

Snoring may not just be an aural irritant
Snoring can be a source of irritation, especially to your sleep partner, but it may also be a symptom of a condition known as sleep apnoea.
Photo: AFP

We often joke about snoring, and the people who are snorers either learn to laugh at themselves or try different treatments to avoid the embarrassment of being teased for snoring loudly.

But this seemingly innocuous habit may be an indication of a condition known as sleep apnoea, where your breathing pattern du- ring sleep is disrupted.

Sleep apnoea causes daytime exhaustion, thus affecting mood and overall health.

Overcome your embarrassment and look for ways to mitigate this potentially dangerous condition.

While you are asleep, sleep apnoea can interrupt your breathing pattern.

The short pauses in your breathing are between 10 and 20 seconds, and disrupt your normal sleep rhythm, as the breaks can occur hundreds of times in one night.

What it means is that your sleep quality is bad, and you're spending more hours in light sleep, rather than the healing deep sleep required for a good night's rest.

Many people who suffer from sleep apnoea are unaware until a partner complains about excessive snoring.

Problems caused by sleep apnea include:

Daytime chronic fatigue: Slow reflexes, lack of focus, sleepiness during the day, and a risk of accidents. It can lead to moodiness, irritability or depression.

Physical health problems: In the long term, a person with sleep apnoea may see the development of health issues such as diabetes, high blood pressure, heart disease, stroke, liver problems and weight gain.

Types of sleep apnoea

There are several types of sleep apnoea. These include:

Obstructive sleep apnoea - The most frequently occurring type of sleep apnoea is obstructive sleep apnoea. This is when the soft tissue located at the back of your throat relaxes during sleep and impedes the air passage, causing you to snore.

Central sleep apnoea - This type of sleep apnoea occurs when the brain does not communicate to the muscles that your breathing needs to be controlled. You seldom snore with central sleep apnoea, but may get woken up when your breathing restarts.

Complex sleep apnoea - This is a mix of the first two types of sleep apnoea. Not much is known about this type, and research is currently being carried out.

Signs and symptoms

The most obvious symptoms of sleep apnoea only show up when you are asleep, making it difficult to identify it by yourself.

Try videotaping your sleep, or ask your partner to take notes on your sleep habits.

If you see a pause when you snore, followed by choking, it is a good chance that you have sleep apnoea.

Major signs and symptoms of sleep apnoea include:

• Loud snoring every night

• Choking, snorting or gasping during sleep

• Pauses in breathing

• Waking up at night feeling short of breath

• Daytime fatigue, despite getting adequate amounts of sleep

Other signs of sleep apnoea may include:

• Waking up with a dry mouth or sore throat

• Insomnia or night-time awakenings

• Going to the bathroom frequently during the night

• Forgetfulness and difficulty concentra- ting

• Uncharacteristic moodiness, irritability or depression

• Morning headaches

• Restless or fitful sleep

• Impotence

Is it sleep apnoea or just snoring?

Bear in mind that just because you are a snorer doesn't mean that you have sleep apnoea.

It is also important to note that not everyone who has sleep apnoea snores.

How can you identify the difference between regular snoring and snoring due to sleep apnoea?

A telltale sign is how much energy you have during your working hours.

Regular snoring will not interfere with the quality of your sleep as much as sleep apnoea does. If you do not experience extreme fatigue during the day, then you may not have sleep apnoea.

We do not yet understand the relationship between hormones and sleep patterns, but what has been found is that breathing disorders during the night are connected to hormone levels.

There are four consistent observations that indicate the relationship:

• Hormone secretion may be interrupted by sleep apnoea, resulting in negative effects.

• Sex hormones like testosterone and oestrogen play an important role in the development of sleep apnoea.

• Obstructive sleep apnoea is more common in males than females.

• Certain medical conditions are a precursor to sleep apnoea. They include hypothyroidism (when your thyroid gland is not producing enough thyroid hormone) and acromegaly (abnormal growth of body parts like hands and feet due to excess production of growth hormones from the pituitary gland).

Possible treatments for sleep apnoea

One of the go-to treatments for sleep apnoea is hormone replacement therapy (HRT). It has been used to treat women who are postmenopausal; but it should be noted that HRT is only useful in mild cases of obstructive sleep apnoea.

The good news is that HRT treatment provides other benefits to those in that age group.

Another common treatment is the use of a continuous positive airway pressure machine (CPAP).

Air is pumped into a face mask, keeping the airways open throughout the night.

The CPAP machine is effective, but has a few disadvantages. It is expensive, can be uncomfortable to wear to sleep, and may cause nasal blockage.

The good news is that there is now new research to suggest that basic throat exercises can be dramatically effective in helping reduce the symptoms of sleep apnoea.

Exercises include swallowing; exaggera- ting vowel sounds; sliding your tongue along the length of your mouth and chewing; and flexing the muscles in the back of the throat.

Patients who tried these exercises 30 minutes a day for three months were found to reduce their sleep apnoea symptoms significantly, and got better quality sleep.

Neck sizes shrunk as well, as a result of following these exercises, and it is believed that larger neck sizes are correlated to sleep apnoea severity.

The causes, symptoms and treatment of sleep apnoea opens up a vast fertile ground for new research.

For those who have not yet found an effective solution to sleep apnoea, there is hope that the additional work in researching the condition will soon lead to advances in treatment.

Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist. For further information, visit www.primanora.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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