Snoring, Apnea and When to Take It Seriously

What to remember

• Obstructive sleep apnea causes repeated breathing pauses and fragmented sleep.
• It is strongly linked to high blood pressure, heart disease and car crashes.
• The classic triad is loud snoring, witnessed pauses, and daytime sleepiness.
• It is treatable, usually very effectively, and treatment transforms daytime function.

Snoring versus apnea

Snoring is the sound of turbulent airflow through a partly narrowed upper airway. Very common, often positional, frequently worse with alcohol, weight gain or nasal congestion. Obstructive sleep apnea is what happens when that airway closes repeatedly: breathing stops for seconds at a time, oxygen falls, and the brain briefly wakes to reopen it. This can happen dozens of times an hour without the person remembering any of it.

Why it matters beyond tiredness

Untreated obstructive sleep apnea is linked to high blood pressure that responds poorly to medication, atrial fibrillation, type 2 diabetes, stroke and heart failure. The most immediate risk is on the road: drivers with untreated sleep apnea have substantially higher crash rates. Rules on reporting conditions that cause excessive sleepiness vary by state and are stricter for commercial drivers, so ask your doctor whether you should drive until it is controlled.

What to look for

The reliable signs are loud habitual snoring, pauses in breathing that a partner notices, gasping or choking awakenings, waking unrefreshed despite adequate time in bed, morning headache, and falling asleep unintentionally during the day. Screening questionnaires used in clinics ask about snoring, tiredness, observed apneas, blood pressure, BMI, age, neck size and sex. Diagnosis is made with a sleep study, often done at home.

Treatment works

CPAP — a mask delivering continuous positive airway pressure — is the standard treatment for moderate to severe obstructive sleep apnea and is highly effective when used. Oral appliances that move the lower jaw forward help in some cases. Weight loss, side sleeping, treating nasal obstruction and reducing alcohol all contribute. People who stick with treatment routinely describe it as the largest change in daytime function they have experienced, which is worth knowing given how many abandon the mask in the first couple of weeks.

The numbers, in one place

Do

• Ask whoever sleeps near you whether you stop breathing or gasp
• See your doctor if you snore and wake unrefreshed, rather than assuming it is normal
• Try side sleeping and reducing evening alcohol while you wait for an evaluation
• Persist with CPAP through the first difficult couple of weeks; most problems are solvable with mask changes

Do not

• Do not drive when sleepy, and do not ignore falling asleep during the day
• Do not treat anti-snoring gadgets as a substitute for an evaluation if you have pauses or sleepiness
• Do not use alcohol or sedatives to sleep; both worsen airway collapse

When to speak to a doctor

See your doctor if you snore loudly and wake unrefreshed, if anyone has seen you stop breathing or gasp in your sleep, or if you fall asleep involuntarily during the day. Do not drive while excessively sleepy, and ask your doctor about driving rules where you live. Call 911 for chest pain, severe shortness of breath, or a person who cannot be woken.

Where this comes from

• National Heart, Lung, and Blood Institute - Sleep Apnea
• American Academy of Sleep Medicine - Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea
• NHTSA - Drowsy Driving

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.