Snoring:

About 30 to 40% people snore at sometime or other. People who snore loudly are often ridiculed, but truly speaking snoring is not a laughing matter. While loud disruptive snoring is a known social problem that may strain relationships, for many men, women and even children, loud habitual snoring may signal a potentially life threatening disorder: obstructive sleep apnea, or OSA.

What is Obstructive Sleep apnea or OSA:

In people who snore sometimes breathing ceases or gets interrupted for few seconds before regaining the normal pattern. These breathing pauses typically last between 10 to 20 seconds and are known as apnoec spells and can occur up to hundreds of times a night, jolting you out of your natural sleep rhythm. Sleep apnea is fairly common. One in five adults has at least mild sleep apnea and one in 15 adults have at least moderate sleep apnea. OSA also affects 1% to 3% of children. During sleep, the upper airway can be obstructed by excess tissue, large tonsils and/or a large tongue. Also contributing to the problem may be the airway muscles, which relax and collapse during sleep, nasal passages, and the position of the jaw. As a consequence, when you get up in the morning you feel groggy and no longer feel fresh. Unlike simple snoring, obstructive sleep apnea is a potentially life-threatening condition that requires medical attention. The risks of undiagnosed OSA include heart attack, stroke, irregular heartbeat, high blood pressure, heart disease and decreased libido. In addition, OSA causes daytime drowsiness that can result in accidents, lost productivity and interpersonal relationship problems. The symptoms may be mild, moderate or severe.

Sleep apnea signs and symptoms:

It is not possible for the person to notice sleep apnea. He or she should ask the bed partner to observe his/her sleep habits, or by recording oneself during sleep.

Major signs and symptoms:-

• Loud and chronic snoring
• Choking, snorting, or gasping during sleep
• Long pauses in breathing
• Daytime sleepiness, no matter how much time you spend in bed

Other common signs and symptoms:-

• Getting up with a dry mouth or sore throat
• Morning headaches
• Restless or fitful sleep
• Insomnia or frequently getting up at night
• Going to the toilet frequently at night
• Forgetfulness and difficulty concentrating

Signs and symptoms of OSA in children: OSA is also commonly seen in children who are obese or who have adenoids and tonsillar hypertrophy. Children with sleep apnea may adopt strange sleeping positions and suffer from bedwetting, excessive perspiration at night, or night terrors. Children with sleep apnea may also exhibit changes in their daytime behavior, like:

• Hyperactivity or inattention
• Developmental and growth problems
• Decrease in school performance
• Irritable, angry, or hostile behavior
• Breathing through mouth instead of nose

Is it just snoring or is it sleep apnea?

Not everyone who snores has sleep apnea, and not everyone who has sleep apnea snores. So how do you differentiate snoring and a more serious case of sleep apnea?

The biggest telltale sign is how you feel during the day. Normal snoring doesn’t interfere with the quality of your sleep as much as sleep apnea does, so you're less likely to suffer from extreme fatigue and sleepiness during the day.

When should you consult your ENT Specialist?

If you are a habitual snorer and you are having few of those above mentioned signs and symptoms then you should immediately consult your family physician/ ENT Specialist.

How is the diagnosis of OSA made?

When you visit your ENT specialist, you must go along with your spouse or bed partner, because he or she is the best witness of your sleep pattern. The Specialist will take detail history and will carry out thorough examination including cardio-vascular examination. You will be put through a whole night sleep study or ‘Polysomnography” during which your various parameters like pulse rate, blood pressure, ECG, apnoec spells(spells of breathing interruption), fall of blood oxygen saturation etc; are recorded and analysed.

Based on the sleep study results it is decided whether one is having OSA or not.

Some non medical remedial measures for reducing snoring:

• 1. Weight loss — as little as 10 pounds may be enough to make a difference.
• 2. Change of sleeping position — Because you tend to snore more when sleeping on your back, sleeping on your side may be helpful.
• 3. Avoid alcohol, caffeine and heavy meals — especially within two hours of bedtime.
• 4. Avoid sedatives — which can relax your throat muscles and increase the tendency for airway obstruction related to snoring.
• 5. Prop your head up — Elevate the head of your bed by four to six inches or elevate your body from the waist up by using a foam wedge. You can also use a special cervical pillow.

How do you treat OSA?

Initially the non medical measures are advised. If still the patient does not get relief the there are two options:

• (a) Non surgical option i.e. use of Continuous Positive Airflow Pressure (CPAP) or Bi-PAP (Bi-Level) machine while sleeping.
• Surgical option:
  1. Laser assisted Uvuloplasty
  2. Coblation assisted UPP.
  3. Radio Frequency assisted soft palate reduction
  4. In case of children simple adeno-tonsillectomy or nasal septoplasty