- Snoring is a common sign of sleep apnea, which can have serious — even life-threatening — complications
- In obstructive sleep apnea (OSA), the most common form, the airway becomes blocked during sleep, leading to reduced or blocked airflow
- Left untreated, OSA is linked to an increased risk of cardiovascular disease and neurocognitive complications, as well as increased morbidity and mortality
- People with untreated sleep apnea also have a greater risk of Type 2 diabetes, heart failure, stroke, high blood pressure and irregular heartbeat, along with a three-fold greater risk of being involved in a motor vehicle accident
- In one study of people with sleep apnea or those who were screened for the condition, 1 in 5 had a high likelihood of OSA, but only 3.5% were treated for it; further, 37.2% had severe snoring while 14.6% reported hypersomnolence, or excessive daytime sleepiness
Snoring isn’t always just a nuisance that can keep you and your partner up at night. It’s a common sign of sleep apnea, which can have serious — even life-threatening — complications. In obstructive sleep apnea (OSA), the most common form, the airway becomes blocked during sleep, leading to reduced or blocked airflow.
Left untreated, OSA is linked to an increased risk of cardiovascular disease and neurocognitive complications, as well as increased morbidity and mortality. People with untreated sleep apnea also have a greater risk of Type 2 diabetes, heart failure, stroke, high blood pressure and irregular heartbeat, along with a three-fold greater risk of being involved in a motor vehicle accident.
However, many people with the condition aren’t aware they have it, putting them at risk of potentially preventable related health issues. So, if you or a family member is a snorer, it’s important to consider OSA as a cause — especially if the snoring is heavy or severe.
A study using data from 20,151 French adults who were being treated for sleep apnea or were screened for the condition revealed sleep apnea was common — but most weren’t receiving treatment.
Among the subjects, 1 in 5 had a high likelihood of OSA, but only 3.5% were treated for it. This suggests “major underdiagnosis in the general population,” according to the study, which was published in ERJ Open Research. Also revealing, 37.2% had severe snoring while 14.6% reported hypersomnolence, or excessive daytime sleepiness. Other factors linked to OSA, or a high likelihood of having it, included:
- Previous cardiovascular events
- Low educational level
- Low physical activity
- Depressive symptoms
“OSA diagnosis should be considered more often in people with risk factors such as depressive symptoms as well as unhealthy behaviors and socioeconomic conditions,” the team, led by led by Dr. Pauline Balagny at the University of Paris-Cité, France, reported. Balagny said in a news release:
“We know that OSA is a major health hazard but if patients are diagnosed with the condition, they can be given treatments and advice to mitigate the risks. Our study suggests that OSA is common, but the majority of those affected do not know they have the condition. Our findings are in line with research in other countries which suggest that OSA is becoming more common.”
It’s estimated that up to 30% of U.S. adults may suffer from OSA, in which muscles and tissues relax during sleep, blocking air from moving freely through your airway. This causes frequent awakenings at night while you try to regain your breath, but they’re so brief you’re unlikely to notice them.
However, the awakenings lead to fragmented sleep that’s not fully restorative. Such episodes can occur up to 30 times an hour in severe cases, seriously interfering with your ability to get deep periods of restful sleep. While regular snoring and excessive sleepiness during the day are among the most common OSA symptoms, others include:
- Interrupted breathing or gasping during sleep
- Headaches in the morning
- Restless sleep
- Trouble staying asleep
- Frequent urination at night
- Irritability and other mood changes
- Decreased concentration or attention span
- Night sweats
- Not feeling refreshed after a night’s sleep
It’s worth noting that it’s also possible to have sleep apnea without any snoring. “It is common for people with OSA to snore. However, the majority of people who snore do not have OSA, and not everyone with OSA snores,” notes SleepApnea.org.
So how can you tell the difference between run-of-the-mill snoring and the more serious type that’s linked with sleep apnea? Snoring due to sleep apnea is often very loud and accompanied by pauses in breathing, leading to choking or gasping for air. Snoring accompanied by any of the OSA symptoms above could also be due to OSA.
Sleep apnea is diagnosed via your sleep history, which may be reported personally (with the help of someone you sleep near) or by spending the night in a sleep disorder center where your breathing can be monitored overnight. Home sleep tests are also available to help with sleep apnea diagnosis.
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Continuous positive airway pressure (CPAP) is considered the “gold standard treatment” for OSA. It delivers continuous air pressure via a small device worn over your mouth, nose or mouth and nose. The air pressure keeps the airway open, so it doesn’t collapse during sleep. This helps prevent a drop in oxygen level during the night and improves sleep quality.
There are downsides to CPAP, however, including the potential to feel claustrophobic while wearing the device. Nasal congestion, dry mucous membranes in the mouth and eyes, or sores where the mask applies pressure over the face during the night are also possible. Mandibular advancement devices (MADs) — a type of mouth device or mouthguard — are an effective alternative that may have fewer side effects than CPAP.
MADs are custom fit by dentists in collaboration with sleep doctors. The device has two pieces that fit over your top and bottom teeth, connected on both sides by a mechanism that’s used to slowly push the lower jaw forward. By changing the position of the lower jaw, it moves the tongue base away from the airway and reduces the potential for obstruction.
The dentist does a physical examination and X-rays to calculate how many millimeters forward your lower jaw must be moved to keep the airway open. The adjustments are made very slowly so it doesn’t change your bite or create jaw pain. One 2017 review of the literature found that CPAP and MADs produced similar results in improving health-related quality of life among people with OSA.
Another treatment option is orofacial myofunctional therapy (OMT), which involves the neuromuscular re-education or repatterning of your oral and facial muscles. It includes facial and tongue exercises and behavior modification techniques to promote proper tongue position, improved breathing, chewing and swallowing. Proper head and neck postures are also addressed.
OMT may be the most profound therapy available for the treatment of mild to moderate sleep apnea. You can find more details in my above interview with Joy Moeller, who is a leading expert in OMT in the U.S.
Breathing through your mouth while you sleep — known as open-mouth breathing or simply mouth breathing — is a risk factor for OSA, which increases both disease severity and the collapsibility of your upper airway.
Writing in the European Archives of Otorhinolaryngology, researchers compared open- and close-mouth breathing, revealing “the more elongated and narrow upper airway during open-mouth breathing may aggravate the collapsibility of the upper airway and, thus, negatively affect OSA severity.”
Breathing techniques can therefore be very effective for sleep apnea, and one of the most basic is to make sure you’re always breathing through your nose. The Buteyko Breathing Method is one way to reverse health problems associated with improper breathing like mouth breathing. It allows you to retain and gently accumulate CO2, which calms breathing and reduces anxiety:
- Take a small breath into your nose, followed by a small breath out
- Hold your nose for five seconds in order to hold your breath, and then release your nose to resume breathing
- Breathe normally for 10 seconds
- Repeat the sequence
Box breathing is another technique, which triggers the parasympathetic nervous system to help manage stress. This technique, also called square breathing or four-square breathing, is used by Navy SEALS to help reduce stress in high-pressure situations.
It involves nose breathing to raise CO2 levels to balance oxygenation. To begin practicing box breathing, get in a quiet place where you can concentrate and maintain good posture. Work up to using the technique for five-minute increments:
- Step 1 — Begin by exhaling the air out of your lungs to a slow count of four. Some recommend exhaling through your mouth, others through your nose.
- Step 2 — Hold your breath for a slow count of four.
- Step 3 — Inhale slowly to a slow count of four through your nose, keeping your back straight and breathing through your abdomen so your shoulders do not rise.
- Step 4 — Hold your breath for a slow count of four and return to step 1.
You can also try the 4-7-8 method, known for relaxation and promoting restful sleep.
First, exhale all your breath. Then inhale through your nose to a count of four. Hold your breath for seven seconds, then exhale, making a whoosh sound, for a count of eight. Repeat the process three times.
Depending on the severity of your sleep apnea, lifestyle changes can be very effective in helping you resolve symptoms, including snoring. Among them:
- Maintain a healthy weight — Obesity is a risk factor for sleep apnea. If you’re obese or overweight, losing even 10% of your body weight may improve sleep apnea.
- Avoid alcohol and smoking — Both of these may make sleep apnea symptoms worse.
- Avoid benzodiazepines — These depressant drugs may worsen sleep apnea.
Breastfeeding is another important strategy that may be able to reduce sleep apnea — an important variable to consider if you’re pregnant or planning to start a family soon. Breastfeeding longer than one month is linked to a lower risk of habitual snoring and apneas.
Researchers believe there may be a “beneficial effect of the breast in the mouth on oropharyngeal [middle part of the throat, behind the mouth] development with consequent protection against upper airway dysfunction causing sleep-disordered breathing.”
Breastfeeding may help expand the size of the child’s palate and shift the jaw forward, helping prevent sleep apnea by creating enough room for unobstructed breathing. Finally, pay attention to healthy sleep hygiene each night. These 33 sleep tips can help you get a good night’s rest whether you have sleep apnea, are a heavy snorer — or both.
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