There are a lot of jokes about the terrible noise that snorers make when they sleep. Many people don't realize that snoring is very often a symptom of a sleep disorder called sleep apnea. Sleep apnea is a treatable disorder, but it must be diagnosed first. My husband's work is in a sleep lab testing people for various sleep disorders, of which obstructive sleep apnea is probably the most common.

A lot of people who snore don't or won't believe that they have a serious medical condition, serious enough that it can kill them without intervention. Many people who die in their sleep have died from a heart attack precipitated by obstructive sleep apnea.

The following article is from about.com sleep disorders. It tells about obstructive sleep apnea from the viewpoint of some with the disorder. This person also has diabetes which is linked with sleep apnea in many people.
_____________________________________________________________

I Have Sleep Apnea
(A Letter from a Reader)
Dateline: 09/14/99
. . .This is a description of a classic case of sleep apnea, made all the more convincing and more poignant because it is written by someone who knows. It is written by a victim of sleep apnea.

My story:

The first time I realized I had a sleep disorder was when my boss told me I literally fell asleep while she was talking to me and yet I was still sitting up in the chair facing her. That was in 1995. I did not slump over into a sleeping position or nod my head but just simply went to sleep, the lights went out in my head but I did not pass out, I went to sleep. When I woke up I argued with my boss that I did not go to sleep because I did not feel like I went to sleep, I didn't feel like anything had happened. I didn't know I was sleeping.

When you have sleep apnea, it is not one of those times you yawn and say to yourself, "gee, gosh I am so tired I could fall asleep right now." You never reach the point when you realize your going to fall asleep, your mind just closes down and your sleeping and you remember nothing when you wake up. You don't realize you woke up because you didn't know you went to sleep. These many moments throughout the day can last only five to ten minutes each time and stretch over many hours. It is caused from total sleep deprivation. What you think is your normal 8 hours of sleep but you never really go to sleep during those 8 hours but you don't know that. I thought I was sleeping all night.

I worked on a job where I was on the phone all day long. It never dawned on me that I had a sleep disorder or any sleep problem period at all. My boss told me on several more occasions that I had fallen asleep again and it is not that I didn't believe her but I was not feeling or experiencing what she was trying to tell me was happening. The sleep moments only lasted for short periods so there was not a long time lapse that she could prove to me that I was in fact asleep.

Then one afternoon while I was alone on the telephone at work I suddenly realized I was hearing a dial tone instead of the customer I was talking to. My pen was still in my hand in a writing position and my notepad had scribbles on it instead of writing. I sat there realizing I had been talking to a customer but they had hung up on me because I obviously was not talking back to them. I must have been writing also to have made the scribbles but I was sleeping. I knew then that my boss was telling me the truth.

The more it happened the more I became aware and I wondered when it would happen again, when did it happen before, where was I, who was I with and were others embarrassed to tell me unlike my boss did. I still did not know I had a sleep disorder. I thought I was just mentally exhausted as I was going through a lot of changes in my personal life and I was toggling another part-time job and then there was my social life I was trying to keep up with as well as family. I was buying NoDoz by the gallons and was drinking coffee all day long but I still fell asleep.

My falling asleep habits got so bad and had now moved into both of my jobs and when I would catch myself that I had fallen asleep I would quickly go to the rest room and hide myself in a bathroom stall, sit on the toilet and I would put my head on the toilet paper roll mounted on the wall and fall asleep thinking that a "little nap" would give me enough sleep to continue through out the rest of the day. But that didn't work and I would have to make more trips to my hidden toilet stall. At lunch time I would go out to my car and sleep and often a friend would come find me to wake me up when they realized I did not return from lunch. I spent more time trying to think of places where Icould go and hide at work to sleep then I was actually doing my job.

One time I was driving the car on one of the local interstates and I had my daughter, nephew and two grandchildren in the car. I was on the express lane and needed to use the ramp to move over to the local lane as we were approaching our exit. I moved the car over toward the right to get on the ramp and the next thing I remember was the wheels of the car bumping on the short 2" section where I needed to move onto the main interstate with the rest of the traffic to reach my exit. When the tires of my car hit that 2" bump I woke up and realized I had fell asleep driving the car with my whole family in it. That is how quick I fell asleep without even realizing it happened. It is not a memory lapse, it is that your sleeping. The rest of the people in the car never knew I fell sleep driving, my head never nodded and they had no indication that anything was wrong but it scared the living hell out of me.

After a whole year of this sleep deprivation lifestyle, I went to the sleep clinic and found out the truth that I had a (OSA) Obstructive Sleep Apnea. Then I also found out I had Hypothyroidism so I take daily medication for that as well as using the CPAP machine with oxygen. It took almost 6-8 months of using the CPAP to begin feeling remotely normal. The CPAP is not 100% guaranteed but it is sure a world of difference between before and after and it is saving my life each time I go to sleep.

Last year I found out I have Diverticulitis which is major problems with your bowels and causes much stomach pain and I have Clinical Depression. I cant work anymore. I am either sleeping, on the toilet (for real this time), in pain or crying. I have filed for disability and am waiting for them to tell me if I am accepted or not. They say it takes up to 6 months for them to determine if you qualify. I am on the CPAP, I take Prozac, Synthroid, Zantac and Metimucal daily. My daily patterns are all based on my medical disabilities and it is something I just learn to live with and adjust my lifestyle to.

Maybe my story will help others realize they are not crazy and they may not be having memory lapses but falling asleep instead. Sleep deprivation is a horrible thing to go through. Sleep Apnea is not like having Insomnia and not being able to get to sleep but you think you are sleeping all night and you don't know you never went to sleep. You don't dream or reach the stage of sleep to be able to dream. Your body is in a state of panic all night just trying to keep you alive andyou don't even know it is happening.

[ April 04, 2002: Message edited by: Linda Sutton ]

All About Sleep Apnea

The term apnea means a pause in breathing. Everyone takes small pauses occasionally in breathing; however, it is abnormal to pause your breathing during sleep for 10 seconds or longer. When breathing completely stops for this long, the term apnea is used. When breathing continues, but is decreased to half of what it had been for 10 or more seconds, the term hypopnea is used.
A condition that includes both apnea and hypopnea is commonly known as obstructive sleep apnea. It is being renamed to be more inclusive of other similar problems and will soon be called obstructive sleep apnea hypopnea syndrome (OSAHS). OSAHS is a disease in which the airway, somewhere from the nostrils to the vocal cords, collapses or closes off during sleep. One of the most fascinating features about this syndrome is that it only occurs in sleep.

Who Gets OSAHS?

What causes a collapse in the upper airway, so one cannot take normal breaths during sleep? It looks as if the primary risk factor for OSAHS in adults is being overweight. Doctors are not entirely sure why being overweight cause apneas. They do know, however, that fat can deposit in certain areas of the upper airway and tongue, making the airway smaller. It also seems that the upper airway is shaped differently in overweight people, which may make the airway more collapsible.

Not everyone who gets OSAHS is overweight. In fact, the biggest risk factor for children is large tonsils. Other people (adults and children) are simply born with narrowed nasal passages, small facial bones (cheek bones and/or jaw bones), or extra-soft tissues within the backs of their throats.

OSAHS is a relatively common disease. At least 4 percent of adult males in the United States have OSAHS and 2 percent of adult females have the disease. As people age, they commonly gain more weight, which causes the upper airway tissues to sag and become more collapsible. For these reasons, OSAHS is even more common in older individuals. Although doctors are still uncertain of the exact numbers, this disease is most likely present in at least 1 percent of children.

Understanding Your Body

When people have OSAHS, why do they breathe normally while awake, but not while asleep? Individuals who have OSAHS use the muscles in the nose, throat and neck to keep the airway perfectly open while awake. One of these muscles is located within the tongue. Most of the tongue is a muscle and, while awake, people keep their tongues forward in their mouths in order to keep the airway behind the tongue open. Other muscles are located within the uvula (the floppy tissue that hangs down in the back of the throat). The uvula has small muscles within it that pull it forward, up, and out of the way for breathing. Other muscles are below the jaw on the front of the neck. These muscles pull the neck tissues forward to keep the rest of the upper airway open.

Everyone has different anatomy. Some people with OSAHS have large tongues and their main problem in sleep is that the tongue moves toward the back of the mouth and closes off the airway. Other people have small facial bones, narrowed nasal passages, a large uvula, large tonsils, or a large neck. All of these people use different combinations of the upper airway muscles described above to keep their airways open. By using some or all of these muscles while they are awake, people do not snore and their breathing is perfectly normal. When someone goes to sleep, it is normal for muscles throughout the body to relax and the airway muscles are no exception. As these muscles relax, the tongue or uvula can fall back in the throat and block the airway; whichever muscles are helping to keep the airway open may relax in sleep and no longer do their job sufficiently. If the airway is completely blocked, a person has an apnea. If it is only partly blocked, the person has a hypopnea.

When people with OSAHS fall asleep and the muscles within the upper airway relax, the amount of air reaching the lungs decreases. This means that the blood oxygen levels will drop and the carbon dioxide levels in the blood will rise. The degree to which an individual's oxygen level drops depends upon how much that person weighs (heavy people have faster and more significant drops in their oxygen levels), how much breathing stops, and how low the person's oxygen level was before sleep. Low blood oxygen levels from apneas and hypopneas decrease the amount of oxygen that the brain, heart and other organs receive. This puts stress on these organs and may predispose people with OSAHS to strokes and heart attacks.

Low oxygen levels continually wake up patients, so that no matter how many hours they sleep, they still feel groggy. Due to the frequent wake ups, people with untreated OSAHS may never get into a deep or dream sleep. The sleepiness, and maybe the low oxygen levels, can have serious adverse consequences on daily life activities including driving and job performance.

Aside from low oxygen levels and sleepiness, people with OSAHS may wake up frequently feeling as if they are suffocating. This sends a big jolt of adrenaline through the body causing the blood pressure to suddenly increase and the heart to race. Studies are under way, which hopefully will determine how dangerous this is for the heart; intuitively, it does not sound healthy to have boosts in adrenaline all through the night. Not all patients remember these episodes because they quickly fall back to sleep and lose the memory of these events.

There are other problems that OSAHS can cause, including reduced sexual performance with a lower sex drive and/or the inability to achieve an erection for males. OSAHS frequently sends bed-partners to sleep in separate bedrooms because of the noise of the apneas. Finally, a substantial number of people with OSAHS have at least a mild depression. The good news is that most of these symptoms can improve dramatically with adequate treatment.

drkoop.com

[ April 04, 2002: Message edited by: Linda Sutton ]

Is this a severe form of sleep apnea? I have never heard of sleep apnea causing you to fall asleep at any time, anywhere before, or is that just my ignorance?

Are all people who snore susceptible to this?

Sarah, I think you must have been writing your post while I was adding my second post. Does the information in it amswer your questions?

The person who wrote the letter had some other medical conditions along with the obstructive sleep apnea. I have known quite a few people with sleep apnea who would appear find as long as they were on the go, but the soon after they sat down and relaxed, they would fall asleep. If I or my husband tried to tell them that they had a problem and needed to be sleep studied, many of them are like the man in the letter, they won't believe they have a serious problem.

Snoring is not always a symptom of sleep apnea, but does indicate that something is causing the air to move noisily though the air passages of the nose/throat. Many people experience that when they have a cold or sinuitis.

There is another condition called narcolepsy which causes people to fall asleep anytime, anywhere. It is unrelated to sleep apnea. I want to post information about it in another topic.

So, snoring can be a symptom but is not necessarily?

I ask because I snore... quite badly sometimes - my husband tends to wake me up to tell me to quit! Is this something that I should be concerned with or is it "normal"?

There has to be some reason why you snore. There are some questions you with your husband need to answer.

quote:

---

The first step in correcting sleep disorders is to correctly diagnose the sleep disorder. You may want to answer a few questions patterned after the Epworth Sleepiness Scale. These include:

• Do you snore?
• Do you stop breathing during your sleep or has your bed partner ever witnessed you stop breathing?
• Are you tired during the day?
• Are you sleepy at inappropriate times such as driving, reading, watching TV, or in social atmospheres?
• Do you have high blood pressure?
• Are you irritable, anxious, or feel depressed?
• Do you ever awaken coughing or gasping for air?
  

If you question whether you may or may not have a sleep disorder, or suspect that you do, contact your dentist or physician for guidance in obtaining a proper diagnosis and course of treatment for these potentially dangerous conditions.

---

quote:

---

Obstructive sleep apnea is best described as breathing that starts and stops during sleep. Complete stoppage of breath is called apnea. Partial obstruction is called hypopnea. Breathing stoppages take place in people whose throats are abnormally small or collapsible. Muscles that normally hold the throat open relax during sleep, and in people with already narrow airways, this can cause the airway to close entirely. As many as five instances of apnea or hypopnea per hour of sleep are considered normal. When more than 15 episodes occur per hour of sleep, a diagnosis of sleep apnea is usually made.

---

If you are having episodes when you stop breathing for several seconds, then gasp and breath again, you may have sleep apnea. It is always best to check with a doctor if you have any question. Snoring is a symptom. You need to know if, in your case, it is a symptom of something serious.

[ April 04, 2002: Message edited by: Linda Sutton ]

Sarah

I think it's time I joined the discussion, since I am a Registered Sleep Tech. (since 1986).

In France all snoring is classified as a form of sleep pathology or sleep related breathing disease.

In normal sleep breathing with no occlusion of the airway, there is no snoring at all. Snoring is the result of partial closure of the airway during sleep.

Snoring is able to range from annoying to the spouse - to the sound of someone arousing from sleep gasping as they resume breathing due to the breaking of their sleep and recovery of muscle tone in the throat that opens their airway enough to breath.

Clinically dying is composed of two progressive steps.

1. Breath stops
2. Heart stops

Biologically dying is composed of three progressive steps.

1. Breath stops
2. Heart stops....can not be revived if "coded" and then
3. Brain stops

Excessive chronic and work induced sleepiness, Exxon Valdesse, Space Shuttle Challenger, millions of machinery & automobile accidents, poor judgements from people in positions of supervison, people in general, a factor in divorce, etc. When human functioned is diminished for any reason, it affects the human & it affects the people the human interacts with or is responsible for.

chronic snoring needs to be diagnosed, it is a symptom of sleep related breathing problems like ( UARS & OSA ) more later.

I have snored since I was a small child (my step-dad used to complain that I kept him awake when we were camping). Once my tonsils were removed, it improved, but I still snore.

Markell advises me that I only snore when I have a cold or am congested, (I've noticed he also wakes me when I am extremely tired and/or lying on my back).

Otherwise, I am frequently very tired, rarely wake up feeling refreshed and have fought depression since I was a teenager. Much improved now, thanks to God, but still tries to sneak up on me occasionally.

I have only woken up choking when I have a horrible cold and everything is stuffed up.

Ed

I didn't know you were an expert in "snoreology."

From my nursing experience; I seem to remember that sleep apnea can be caused by obesity as well?

[ June 06, 2002, 05:04 AM: Message edited by: Benaiah ]

Ed made some very vaulable posts on this subject in a thread titled "Sleep Deprivation." While he did not begin the thread, it would do you-all well to go there and read those posts.