Updated August 18, 2009

Do you keep your mate or family up all night with snoring? Do you feel chronically tired throughout the day? Although you may not realize it, you could have a potentially fatal disorder called sleep apnea. Studies estimate that approximately 45% of men and 30% of women snore regularly, and snoring is the main symptom of sleep apnea. However, with sleep apnea, the snoring is accompanied by the repeated failure to breath throughout the night.

According to the National Institutes of Health, sleep apnea affects 12 million Americans. One in four men and one in ten women suffer from it. Unfortunately, even though it is a common disorder, many people do not realize they have it. Furthermore, it increases the risk of death.

The disorder derives it name from the Greek word apnea which means without breath. Thus, an apnea can be defined as minimum 10 second interval between breaths with either a neurological arousal or blood desaturation level greater than 3% to 4% or both.

Sleep apnea not only causes daytime sleepiness and fatigue, but it can other serious health problems too. These problems may include: high blood pressure, cardiovascular diseases, strokes, memory problems, weight gain, impotency, headaches, diabetes, and decreased alertness.

Numerous studies have been done on sleep apnea. A Wisconsin Sleep Cohort Study monitored 1,522 random men and women for sleep apnea. After spending a night in a sleep study, they were divided into two groups, those with and without sleep apnea. During the 18 years of follow-ups, 80 people died. After adjusting for other factors, they found those with severe sleep apnea symptoms were 3.2 times more likely to die than those without it. Furthermore, 42% of these deaths were related to heart disease. Another study involved 92 people who had recently had a heart attack. Approximately 17 days after their heart attacks, they participated in a sleep study. The study found that 64 out of the 92 people had severe sleep apnea. The group with sleep apnea was six times more likely to have a heart attack in between the hours of 12 A.M. to 6 A.M. rather than 6 A.M. to 1 P.M. This led the researchers to conclude that obstructive sleep apnea may be a trigger for heart attacks.

Not only does sleep apnea increase the risk for heart attacks, it can increase the risk of dying independent of any lifestyle factors or medical conditions. According to new research, breathing problems for a little as 11 minutes per night can double the risk of death. Middle-age people with severe sleep apnea are 46% more likely to die from any cause while middle-age people with moderate sleep apnea are 17% more likely to die from any cause. Dr. David Schulman, director of the sleep laboratory at Emory University Hospital at Atlanta, said, "People with sleep apnea today are more likely to die tomorrow."

Causes of Sleep Apnea

There are three types of sleep apnea: obstructive, central, and mixed. Approximately 84% of sleep apnea cases are obstructive, 15% are mixed, and 0.04% are central. Obstructive sleep apnea is caused by a blockage of the airway. Soft tissue in the rear of the throat collapses and closes during sleep. Unlike obstructive sleep apnea, cental sleep apnea occurs because the brain fails to signal the individual to breath. This type normally occurs in infants or in adults with heart disease, cerebrovascular disease, or congenital diseases. However, some cases may also be caused by medications or high altitudes. Like the name implies, mixed sleep apnea is a combination of obstructive and central apnea.

Several risk factors are associated with sleep apnea. These risk factors are:

• Over 40 years of age
• Being overweight
• Male
• A family history
• Large necks (over 17” for a man, over 16” for a woman)
• Larger tonsils.

The symptoms of sleep apnea are self-evident. These symptoms include:

• Snoring
• Daytime sleepliness
• Fatigue
• Restless sleep
• Awakening with a sore or dry throat
• Morning headaches

Just because you snore doesn’t mean you have sleep apnea, however, the two usually go hand-in-hand, especially in obstructive sleep apnea and mixed sleep apnea. Snoring results when the air flow through the mouth or nose is obstructed, and the throat and or surrounding tissues vibrate. This can be caused by obstructed nasal airways; poor muscle tone in the tongue and throat; bulky throat tissue; and a long, soft palate or uvula.

Snoring is not only problematic for those who live with you, it can be a problem for you, too. Although you may not be aware of your snoring, it can repeatedly, momentarily wake you up throughout the night. The cumulative effects of sleep apnea and the lack of quality sleep causes numerous health problems and increase the risk of death.

The only way to diagnose sleep apnea with certainty is through a polysomnogram, a comprehensive study that monitors and records sleeping activities. Polysomnograms usually involve an overnight stay at a sleep disorder center or hospital. Sometimes they videotape you while you’re sleeping. Regardless, you’re monitored by staff throughout the night. Various monitors hooked to a patient are also hooked up to a computer so the data can be stored, displayed, and analyzed. These monitors usually include:

• EEG (electroencehphalogram) - measures and records brain wave activity
• EMG (electromyogram) - measures and records muscle tension and monitors excessive leg movements
• EOG (electrooculogram) - measures and records rapid eye movements
• EKG (electrokardiogram) - records heart rate and rythym
• Pulse Oximetry - monitors changes in blood oxygen levels
• Nasal and Oral Airflow Sensor
• Snore microphone - records snoring activity
• Monitor body position and movement

Mild cases of sleep apnea may be treated by lifestyle changes. These lifestyle changes may include:

• Losing weight - Although weight loss is recommended for those with sleep apnea, one study suggested it may not make very much of a difference. Twenty-four severely obese patients were tested for sleep apnea before and after a weight loss surgery. After a year, their body mass index went from 51% to 32%, yet all but one still had sleep apnea.
• Avoiding alcohol and sleeping pills
• Quit smoking
• Avoid sleeping on your back.

More severe cases of sleep apnea may involve more aggressive treatment. These treatments may involve oral devices, mechanical sleeping aides or surgery. Mechanical sleeping aides include the CPAP, the biPAP, and APAP.

• Oral Appliance Therapy (OAT) - an oral device that moves the jaw forward so the the throat doesn’t collapse when it is relaxed.
• CPAP - a machine that uses a constant rate of pressurized airflow to keep the airway open
• APAP - a machine that uses the minimum airflow needed to ensure breathing on a breath-to-breath basis.
• BiPAP - a machine that uses two different airflows, a higher pressure for inhalation and a lower pressure for exhalation.
• Adaptive servo-ventilation (ASV) - This machine learns your normal breathing patterns and stores it in a computer. The machine simulates your normal breathing patterns with pressurized air to maintain constant breathing.

In addition to mechanical sleeping aides, there are also surgical treatments. The surgery is designed to correct the anatomical defects that are the roots of snoring. The most common surgical treatments include:

• Somnoplasty - Reduces soft tissue in the upper airway
• Nasal surgery - Correction of nasal obstructions
• Uvulopalatopharyngoplasty -Removes soft tissue in the back of the throat and palate
• Mandibular maxillar advancement surgery - The upper and lower part of the jaw is moved forward from your face bones to enlarge the space behind the tongue and soft palate
• Pillar palatal implant - an out-patient procedure done in a doctor’s office under a local aneasthetic. In this procedure, three pieces of polyester net are inserted into the soft palate where the soft palate meets the hard palate.

Although sleep apnea is a common disorder, it can be serious too. Unfortunately, if left untreated, the risk of premature death is three times higher in those with sleep apnea. Therefore, if you have any of the symptoms related to sleep apnea or partner notices you repeatedly stop breathing throughout the night, you should seek medical treatment. Early diagnosis and treatment can help you sleep better and may even prevent unnecessary death.