FAQ

About snoring and OSA (Obstructive Sleep Apnea)

An Introduction To Snoring

Snoring is defined as a coarse sound made by vibrations of the soft palate and other tissue in the mouth, nose & throat (upper airway). It is caused by turbulence inside the airway during inspiration. The turbulence is caused by a partial blockage that may be located anywhere from the tip of the nose to the vocal chords. The restriction may occur only during sleep, or it may persist all the time and be worse when we are asleep. This is because our muscle tone is reduced during sleep and there may be insufficient muscle tone to prevent the airway tissue vibrating. During waking hours muscle tone keeps the airway in good shape; that’s why we don’t snore when awake.

Snoring can originate from the nose, oropharynx or the base of the tongue. In recent years it has been found that the tongue plays a far more important role in the incidence of snoring than was once thought.

Snoring is something that cannot be stopped at will, neither is it something that can be ‘cured’. It can however, be successfully controlled. Snoring is caused by a physical abnormality that needs to be identified before a control can be found. This is not as difficult as it seems and the good news is there is a control for everybody.

Finding the cause is the key to finding a solution. In most instances snoring can be controlled by simple self-help remedies like a Goodsomnia device.

Physical Features Of Snoring

Snoring is caused by a physical abnormality that needs to be identified before a control can be found. This is not as difficult as it seems and the good news is there is a control for everybody just give us 30 seconds a day for snoring problems and 1 minute for OSA problems during 2 – 4 weeks. However you will start to notice changes from day one.

• Fat deposits around the neck – double chin

• Obstruction at the back of the tongue caused by a ‘weak chin’

• Small or collapsing nostrils

• Deviated septum

• Nasal congestion and catarrh

• Enlarged nasal turbinates and nasal polyps

• Large soft palate or uvula.

+30 % of population’s world-wide snore or suffer from OSA (Obstructive Sleep Apnoea) problem.

30% of people age 30 and older snore

40% of people age 40 and older snore

19% of women snore

59% of people who say their partner snores

5.6% of children snore

28% of people who snore also experience sleep apnea OSA

38dB is average decibel level of a snore

The Causes Of Snoring

Soft palate movements when breathing is the main cause of snoring. Snoring is the result of our airways collapsing as the upper throat muscles relax during sleep. When we breathe through the narrowed airway, we create vibrations that are heard as snoring. Ageing, congenital problem, overweight, alcohol, tobacco and unhealthy lifestyle in general are the main reasons. Complications from OSA include high blood pressure, cardiac arrhythmia, stroke, depressions and dementia. Danger of nodding off briefly, risk of traffic accidents triples and accidents at work increases, etc.

It is said that snoring is often the result of overindulgence in some of life’s pleasures. The following are the causes of snoring and by controlling them, you can become quiet at night.

• Overeating and/or Lack of Exercise

• Alcohol and Sleeping Pills

• Smoking • Sleeping Position

• Allergy

• Nasal Stuffiness

• Mouth Breather

• Small or Collapsing Nostrils

• Tongue Base Snorer

• Multifactoral Snoring.

Snoring & Sleep Apnoea in Women

Snoring and sleep apnoea are generally considered to be conditions affecting men. It is accepted that most men snore but it is not very ladylike for women to snore. This may be one reason why women are reluctant to seek help. However, what is not recognised is that women tend to present with different symptoms to men that are often overlooked when seeking help. As a consequence their condition remains undiagnosed or often misdiagnosed. When considering these atypical symptoms it becomes clear that hormones and airway anatomy play a prominent role in women who snore and most importantly, explain the different mechanisms between women and men. Identifying the atypical symptoms of women is paramount to an early diagnosis and successful treatment.

Overeating / Lack of Exercise

Overeating and/or lack of exercise leads to an increase in fat around the throat. If you have a collar size of 16½ inches or greater, you may not have the muscle tone needed to keep the airway open sufficiently at night to allow normal breathing, and the narrow airway is more likely to vibrate. A person with a short fat neck is at an increased risk of snoring. Excess body fatseems to be more of a problem for men than women. Men tend to get fat around their necks and waists, whereas women seem to put on weight around the thighs. In women, the cross sectional area of the upper airway is greater and the airway walls may be more rigid and therefore less prone to yield to pressure. As a result, collapse of the airway is resisted when muscle tone falls during sleep. This means that women are less likely to snore than men. However, this situation very often changes for women following the menopause. Like men, as women get older their muscle tone tends to diminish and they put on more weight. By the time women have reached the age of 70 they are just as likely to be snorers as men of the same age.

Being overweight by just a few kilograms can be the cause of your snoring. If you have fatty tissue around your neck you will find that during sleep it squeezes the airway and prevents air from flowing in and out freely.

Weight loss with accompanying fat reduction will certainly help to alleviate snoring. However, weight loss cannot be achieved by diet alone, it must be accompanied by a sensible exercise programme.

Alcohol and Sleeping Pills

Alcohol travels to all areas of the body and slows the brain’s responses, causing the muscles to relax even more than during a normal night’s sleep. Alcohol also acts as a depressant. The added relaxation of the musculature causes the oropharynx to collapse more readily causing further snoring. Additionally alcohol can induce obstructive sleep apnoea (where breathing stops for short periods during sleep) in individuals who are otherwise just snorers. This does not mean that you have ‘clinically recognised sleep apnoea’ but, when you have been drinking alcohol and your sleep is interrupted by periods of not breathing, you should be aware that if you do not modify your lifestyle, this condition will worsen. It is very much more difficult to treat sleep apnoea than it is to treat simple snoring.

Alcohol also causes nasal airway irritation and congestion that increases the airway resistance when breathing. The consumption of alcohol affects every organ and system in the body. It can damage heart tissue and elevate blood pressure. It also has a high calorie content, and people who are heavy drinkers are often overweight.

If you cannot stop drinking you can modify the effects by having your last drink at least 4 hours before you go to bed. This will give your body sufficient time to reduce the effects of the alcohol and help you to sleep without snoring.

Whilst most people have sufficient muscle tone to prevent the airway from collapsing during sleep this situation may alter if you are taking sedatives. So, if you are taking any medication that has a sedating effect, ask your doctor for a non-sedating alternative. Naturally, you should never stop taking prescribed medicines without your doctor’s consent.

Smoking

Cigarette smoke irritates the lining of the nasal cavity and throat causing swelling and catarrh. If the nasal passages become congested it is difficult to breathe through your nose because the airflow is decreased. The likelihood of snoring increases as more cigarettes are smoked per day because the congestion increases with each cigarette. Even passive smoking can cause inflammation of the nose and throat passages, thus increasing the risk of snoring. Children of parents who smoke are more likely to be affected by snoring than children of non smoking parents. If you cannot stop smoking you can modify the effects by having your last cigarette at least 4 hours before you go to bed. This will give your body sufficient time to reduce the effects of the cigarette smoke and help you to sleep without snoring.

Sleeping Position

Body position plays an important role during sleep and can often make the difference between having a good night’s sleep or not. For snorers and individuals who suffer from obstructive sleep apnoea (OSA), this is a particular problem as several studies have found that individuals who sleep in the supine position (on the back) are more likely to snore or have increased apnoeas than those who sleep in the lateral position (on the side). The physiological mechanism for this is most probably due to the effects of gravity on the upper airway. When sleeping in the supine position, gravitational forces increase the tendency for the tongue and soft palate to fall back into the throat. This creates a narrowing of the airway and the likelihood of airway obstruction that leads to a number of breathing abnormalities. The airway tends to be more stable in the lateral position and less likely to collapse.

Individuals who suffer ‘retrognathia’ (receding chin) tend to snore when sleeping on their back. The unusually shaped jaw pushes the structures of the upper airway towards the back of the throat, narrowing the airway so that snoring occurs.

Snoring and apnoea events seem to be more numerous and more severe in the supine position than in the lateral position. One study demonstrated that more than half of their OSA patients had twice as many apnoeas in the supine position than in the lateral position. Interestingly, lateral positional OSA patients are reported to be thinner and have less severe apnoea than supine positional patients. Similarly, lateral snorers are reported to have less severe snoring than those who sleep on their back.

The clinical evidence, regardless of opinion, is unanimous in suggesting that both sleeping position and sleep stage have a considerable impact on both snoring, sleep apnoea and other sleep disorders. Although it would seem desirable to prevent snorers from sleeping on their back, in practice this is rarely achieved.

Sleep Stage

Sleep stage seems to have more of an effect on snoring independent of body position. Sleep stage affects snoring time and intensity. However, there are differing opinions as to what stage of sleep is of more significance. Some studies report snoring and apnoeas are more prominent in SWS (slow wave sleep), followed by Stage 2 and least in Stages 1 and REM (rapid eye movement). Other studies report snoring and apnoeas are more prevalent during REM sleep. One study reported a higher prevalence of continuous snoring in SWS than in REM and concluded that this could be due to a higher airway resistance in SWS or to the regularity of the breathing pattern. During Stages 1 and 2 of sleep, breathing is frequently periodic and in REM it is irregular with more pauses. Consequently, during light and REM sleep, the incidence of respiratory arrhythmias (changes in breathing pattern) would be high but continuous snoring would be unlikely.

It is thought that sleep position may also have an effect on individuals who suffer sleep bruxism (teeth grinding). In one study, patients were found to have averaged 19 clenches per hour in the supine position as opposed to 15 clenches in the lateral position. This study also found that clenching was associated with sleep stage. Patients who slept in the lateral position had a decrease in the amount of Stage 2 sleep (and an increase in SWS & REM) that resulted in less clenching activity.

Allergy

Allergies and in particular allergic rhinitis are increasing in prevalence and currently affect between 10-25% of the population. The most common symptoms include: nasal congestion, rhinorrhoea, itching, postnasal drip and sneezing. However, daytime sleepiness, disrupted sleep at night, fatigue, headache, decreased cognitive performance and malaise can also be the consequence of allergic rhinitis but these symptoms are not always recognised as being associated with allergy.

Impaired sleep not only causes daytime somnolence and fatigue but can decrease our productivity, increase our risk of accidents, alter our mood and affect our quality of life. Until now, it has not been easy to prove a direct cause and effect relationship between rhinitis and impaired sleep. However, a recent study by Fisher et al (2005) compairing allergic rhinitis patients with controls, found statistical evidence suggesting that daytime sleepiness and quality of life correlated with the severity of rhinosinusitis. The research also found that for those individuals who suffered allergic rhinitis when sleeping in the supine position (on the back), the congestion in their nasal airway increased. This was particularly evident during the early hours of the morning, which affected their circadian rhythms and consequently their sleep quality.

Congestion in the nasal airway can lead to sleep disordered breathing and snoring. From a questionnaire based study of 5000 subjects who frequently suffered rhinitis symptoms, it was found that they were significantly more likely to be snorers, have non-restorative sleep and excessive daytime sleepiness. The study also found that subjects with nasal congestion were almost twice as likely to have moderate to severe sleep disordered breathing than normal subjects. Statistical findings similar to the previous study found that both nasal congestion and rhinitis were significant factors in sleep disruption, especially when sleeping on the back, with all symptoms being worse in the early morning hours. Respiratory allergy is the result of nasal hypersensitivity or hyperactivity. The lining of the nose and throat swells which prevents correct breathing through the nasal airway and is often worse at night. Symptoms are typically the same as those of allergic rhinitis and can have similar devastating effects on quality of life.

Known causes of allergic rhinitis and respiratory allergy include: dust particles, tobacco smoke (including passive smoking), feather pillows & bedding, dung of house dust mite, pet hair, indoor plants & flowers, perfumes, some household cleaners and paint smells.

Obstructive Sleep Apnoea (OSA) is defined as the cessation of airflow during sleep preventing air from entering the lungs caused by an obstruction. These periods of ‘stopping breathing’ only become clinically significant if the cessation lasts for more than 10 seconds each time and occur more than 10 times every hour. OSA only happens during sleep, as it is a lack of muscle tone in your upper airway that causes the airway to collapse. During the day we have sufficient muscle tone to keep the airway open allowing for normal breathing. When you experience an episode of apnoea during sleep your brain will automatically wake you up, usually with a very loud snore or snort, in order to breathe again. People with OSA will experience these wakening episodes many times during the night and consequently feel very sleepy during the day: they have an airway that is more likely to collapse than normal.

How Do I Know I Have Sleep Apnoea?

People with sleep apnoea may complain of excessive daytime sleepiness often with irritability or restlessness. But it is normally the bed partner, family or friends who notice the symptoms first. Sufferers may experience some of the following:

• Extremely loud heavy snoring, often interrupted by pauses and gasps

• Excessive daytime sleepiness, e.g., falling asleep at work, whilst driving, during conversation or when watching TV. (This should not be confused with excessive tiredness with which we all suffer from time to time)

• Irritability, short temper

• Morning headaches

• Forgetfulness

• Changes in mood or behaviour

• Anxiety or depression

• Decreased interest in sex

Remember, not everyone who has these symptoms will necessarily have sleep apnoea. We possibly all suffer from these symptoms from time to time but people with sleep apnoea demonstrate some or all of these symptoms all the time.

Diagnosing Sleep Apnoea

OSA can range from very mild to very severe. The severity is often established using the apnoea/hypopnoea index (AHI), which is the number of apnoeas plus the number of hypopnoeas per hour of sleep – (hypopnoea being reduction in airflow). An AHI of less than 10 is not likely to be associated with clinical problems. To determine whether you are suffering from sleep apnoea you must first undergo a specialist ‘sleep study’. This will usually involve a night in hospital where equipment will be used to monitor the quality of your sleep. The results will enable a specialist to decide on your best course of treatment. The ultimate investigation is polysomnography, which will include:

• Electro-encephalography (EEG) – brain wave monitoring

• Electromyography (EMG) – muscle tone monitoring

• Recording thoracic-abdominal movements – chest and abdomen movements

• Recording oro-nasal airflow – mouth and nose airflow

• Pulse oximetry – heart rate and blood oxygen level monitoring

• Electrocardiography (ECG) – heart monitoring

• Sound and video recording

This is a very expensive investigation, with few centres able to offer it routinely for all suspected sleep apnoea patients. A ‘mini’ sleep study is more usual, consisting of pulse oximetry and nursing observation. Home sleep study is becoming more popular.

Central & Mixed Sleep Apnoea

OSA is the commonest form of sleep apnoea, (about 4% of men and 2% of women) but there is also a condition called Central Sleep Apnoea (CSA). This is a condition when the brain does not send the right signals to tell you to breathe when you are asleep. In other words the brain ‘forgets’ to make you breathe. It can also be associated with weakness of the breathing muscles. The assessment for CSA is often more complicated than for OSA and the treatment has to be carefully matched to the patient’s requirements. There is also a condition called Mixed Sleep Apnoea that is a combination of both obstructive and central sleep apnoea.

Snoring can contribute to fatigue and morning tiredness. This can add risks to driving and any occupation where workplace tiredness can lead to a lowering of safety. There appears to be an increased risk of high blood pressure and stroke in snoring patients.

Where snoring is accompanied by significant sleep apnoea, additional health risks may occur.

Even children are not immune to sleep apnea, but it’s not quite as easy to recognize as it is in adults. Children who suffer from apnea may sleep in strange positions, can suffer from bedwetting, excessive perspiration or night terrors.

Daytime behavior to watch for includes hyperactivity, developmental or growth problems, poor performance in school and mouth breathing. The best course of action is to visit your doctor.

Obstructive Sleep Apnea, or OSA is often associated with chronic snoring. It can cause long interruptions, over 10 seconds, in the sufferer’s breathing while they are asleep. This happens because the airway is blocked and the suffer can no longer breath.

These episodes can happen a few times – to hundreds of times a night. When the sufferer stops breathing, the body will wake him or her up, resulting in a very disrupted sleep throughout the night. This will obviously bring constant, daily fatigue, reducing the sufferer’s quality of life.

Because the airway is obstructed, the oxygen level in the blood is reduced. This makes the heart pump even harder than normal and that results in increased blood pressure. Prolonged suffering of OSA can result in high blood pressure and enlargement of the heart, with higher risks of heart attack and stroke.

When we don’t get enough oxygen, our bodies produce adrenalin. Adrenalin is a chemical that our bodies use to cope with stressful situations. Unfortunately it also causes the blood sugar to rise, which might eventually lead to diabetes.

This is why it is extremely important to see your doctor if you think you, or a loved one is suffering from OSA.

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