Snoring and Sleep Apnea: Putting Problems to Bed

What is sleep apnea?

Sleep apnea is a condition where during sleep the muscles of the airway relax and collapse shut, cutting off the oxygen supply to the heart and brain. The body does not get into deep sleep and will struggle to re-open the airway, sometimes making a snoring, gasping, or choking sound. When this happens repetitively over the night, it leads to increased stress on the body which can lead to the development of other chronic health problems.

What health problems are caused or made worse by untreated sleep apnea?

Some of the health problems that have been linked to sleep apnea include obesity, hypertension, diabetes, stroke, atrial fibrillation, heart disease, clotting disorders, and cancer. In children, sleep apnea has been associated with changes in growth, learning, aggressive behavior, and attention span.

What are the common signs of having sleep apnea?

Some of the common signs of having sleep apnea in children include snoring, mouth breathing, hyperactivity, aggressive behavior, and poor academic performance. On physical exam, they may have enlarged tonsils and adenoids, mouth breathing, and a narrow palate. Some signs of sleep apnea in adults include daytime sleepiness, inability to concentrate or difficulty with memory, dry mouth, headaches, snoring, waking up to go to the bathroom, and automatic behaviors (i.e., arriving at a destination but not remembering the journey, being on autopilot). On physical exam, adults may have increased neck size, obesity, overbite and small or narrow jaw, large tongue, low soft palate, and a large uvula (soft tissue which hangs down the back of the throat).

What makes sleep apnea worse?

Sleep apnea is made worse by weight gain, alcohol, sinus congestion, sleeping supine (on your back), hypothyroidism, and testosterone supplementation.

How is sleep apnea treated?

The most common treatment is a mask with pressurized air, called a CPAP (continuous positive airway pressure) or Bilevel / BiPAP (higher air pressure when you breathe in and low air pressure when you are breathing out). The air pressure from the mask holds the throat open and keeps it from collapsing so that oxygen can get to the heart and brain. The mask must be worn every night when sleeping, for at least four hours a night to get the benefits and prevent the stress of low oxygen on the body. Wearing extra oxygen at night will not treat sleep apnea, because the oxygen cannot pass through a collapsed throat. Other treatments for apnea can include a dental device, nasal devices, oral surgery, nerve stimulation, or placement of a tracheostomy (in extreme cases).

Can sleep apnea be cured?

Sleep apnea can be “cured” if the causes of apnea are reversed. For children, this is usually accomplished by surgery to remove the tonsils and adenoids. Kids with a narrow palate may require a palate expander bar. For adults, this is most commonly done by reducing one’s weight if obese and having airway surgery. However, this may not work for everyone and some patients will need to stay on positive pressure nocturnal ventilation for life.

What should I do if the mask is uncomfortable or can’t sleep with it?

Masks need to be custom fit, like shoes. Most sleep labs and sleep physician offices can perform mask fittings. There are more than 50 different types and styles of masks currently available. If you are not offered enough choices, you may want to speak to your sleep physician about your options. A properly fit mask should not pinch the skin or leave marks on your face in the morning. You should always be able to slide your finger underneath the mask and slide your mask on and off over the top of your head (like a baseball cap) without releasing the straps. The mask can leak some air but should not leak air into your eyes. If you have difficulty falling asleep with the mask on, you can try wearing during the daytime when relaxing or watching TV to help you get used to it (mask desensitization), You can also use medications, such as sleeping pills, to help you initially fall asleep with the mask on. Be sure that your bedroom is free of light and noise, and that your bed and room temperature are comfortable to also help induce sleep.

What should I do if the air pressure is uncomfortable?

Your sleep physician may be able to adjust the air pressure to allow you to have more comfort with the machine. Ramp features allow the pressure to start low and slowly increase over the night. Auto-titration features allow for the pressure to vary depending on how deep your sleep is. There are even machines that can time the cycling of the mask to coincide with your breathing. Rarely, the sleep physician may need to reduce the pressure initially and slowly increase it over several weeks to allow you to build a tolerance to it. Getting used to the pressure is like getting used to wearing glasses or a hearing aid, it sometimes takes time.

What should I do if I have a very dry mouth when using the mask?

Most machines can have heated and humidified air added, which may make this more comfortable. Saline nasal sprays and saline nasal gels also help. Over the counter, mouth rinses for dry mouth may help, as may lemon glycerin mouth swabs. Sometimes the addition of a chin strap, to prevent the mouth from popping open during the night, may also help.

How do I know if I need my pressure or the machine needs adjustment?

The pressure or machine may need adjustment if you again start snoring or have worsening of your daytime sleepiness. It should also be adjusted if you have significant weight gain.

Self-Check for Management of Sleep Apnea
  • I have discussed options for treatment of sleep apnea and have decided on a pressurized mask, surgery, or a dental device for immediate management.
  • If I am obese, I have decided on a medical or surgical weight loss program.
  • I will have my children evaluated for enlarged tonsils or dental or jaw problems which may be easily corrected in childhood and prevent them from developing sleep apnea.
  • I have had my mask properly fit and it is comfortable.
  • I know how to clean my machine and when to replace the mask, tubing, and filters.
Managing Doctors
  • Primary Care
  • Sleep Medicine
  • Ears, Nose Throat (ENT)
  • Sleep Dentist
  • Oral and Maxillofacial (OMF) Surgeon
  • Bariatric Physician
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