Snoring has always been equated with deep restful sleep according to traditional folkore. “Snoring peacefully” has almost gained the universal stamp of approval. However, recently there has been a growing awareness of a serious sleep problem that can be very deleterious for our health. This condition is known as “Obstructive Sleep Apnea” and snoring is one of the features of it. There is growing evidence that it can also lead to various heart ailments including heart attacks and abnormal heart rhythms that may lead to death.
Recently, I had written about the importance of sleep and its beneficial effect on the heart. This needs to be furthered qualified. The quality of sleep is very important. Fragmented sleep and obstructed sleep patterns can be very dangerous for the heart and the rest of the body.
Obstructive Sleep Apnea simply stated means, unrecognized difficulty in allowing air into the lungs while sleeping (implying that the muscle tone of the breathing passages may be very relaxed to the point of collapsing during the inbreath.) As the awareness is increasing, it is estimated that up to 4% of the population suffers from it. This includes men (greatest risk), women (slightly lower risk) as well as upto 3% of all children. Most common cause of snoring in children is enlargement of the tonsils and adenoids. In adults, the most common cause is “weighing too much”. The technical term is obesity, which means weighing 20% over your ideal body weight. There are other causes as well which have to do with the architecture of the mouth and throat leading down to the breathing passages.
Although snoring is the most obvious sign of potential sleep apnea, the most damaging part is brief periods of complete cessation of breathing. These episodes can be as brief as 10 seconds and occasionally much longer. This lowers oxygen level to below 90%, which is considered dangerous. Normal oxygen levels are 96-100%. It is felt that lowering of the oxygen levels taxes the heart and the brain significantly.
Some of the common signs and consequences of OSA are snoring, usually brought to attention by family members and occasionally neighbors. Most people are not aware that they snore. (although, I have seen several patients who wake up because of their own loud snoring). Typically, people are shocked to find out that they snore. Other features include fatigue daytime sleepiness, morning headaches, sensation of choking, poor memory, difficulty in concentrating, poor performance at work. Usually there is associated high blood pressure, history of depression and hypothyroidism. The only way to truly diagnose this condition is to undergo a sleep study in a qualified lab under the direction of a sleep specialist.
In the event that sleep apnea goes unrecognized, it can lead to several conditions. Initial complications include abnormal heart rhythms, high blood pressure. Over time this can lead to strain on the right side of the heart. Swelling in the legs is a common consequence. Severe consequences include heart failure, heart attacks and strokes.
Typically, in patients with high blood pressure, a fair number will have OSA. Recently, it has also been associated with automobile accidents, most likely due to daytime sleepiness.
The first step to the treatment is awareness and then diagnosis. Subsequently, based on individual assessment, treatment includes weight loss, High pressure oxygen mask (known as CPAP) while sleeping and in some cases, surgery can be corrective. Some general measures we can all take to reduce the likelihood is as follows:
1) Maintain ideal body weight (or as close to it as possible)
2) Exercise – this has not been conclusively proven, but it is felt that exercising does improve muscle tone and swelling in the breathing passages and leads to weight loss
3) Avoid alcohol
4) Avoid sedatives including sleeping pills
5) Comfortable sleeping position with emphasis on proper alignment of the neck while sleeping
Seek evaluation if you develop any of the following signs and symptoms:
1) daytime sleepiness
2) loud snoring with periods of complete stoppage of breath as observed by family members
3) awakening in the middle of the night with a sense of panic
5) choking sensation upon awakening
6) swelling in the legs
7) unexplained headaches in the morning (excluding hangovers)
8) decreasing memory and ability to concentrate
9) irritability and progressive decline in work performance
Sleep Apnea does occur in various degrees of severity. However, prompt attention to even milder degrees can reduce the risk of a heart attack and a stroke. Even in the absence of sleep apnea, poor sleep patterns can be picked up which after treatment can significantly improve lifestyle and increase daytime energy.
The contents are meant for informative, educational purposes only. Formal recommendations can only be made by physicians involved in your care. Please check with your physician before acting on any part of this article.
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