Snoring may be sound of a serious sleep disorder

March 30, 2000
Web posted at: 10:05 AM EST (1505 GMT)

In this story: It can be dangerous Signs of sleep apnea A good night's sleep RELATEDS

(WebMD) -- As Frank Ternan tells it, his wife Pat's snoring became unbearable when their boat was docked during a sailing trip on Lake Ontario 10 years ago. "We were all cooped up in a small cabin," says Ternan, of Calgary, Alberta, "and the snoring got worse and worse until (the bed) was vibrating back and forth." The couple's oldest son, Chris, unable to sleep, left his bunk in the middle of the night. Frank found him the next morning curled up on a bench on the dock.

The person responsible for all the racket was also having trouble getting a good night's sleep. Fatigued during the day, Pat would go to bed early and wake the next morning still exhausted. She'd fall asleep even while reading a book after lunch. What Pat didn't realize, however, was that her snoring was more than the "noisy nuisance" she considered it to be. It was also a serious health hazard.

Pat Ternan, 58, suffers from obstructive sleep apnea. The National Sleep Foundation defines sleep apnea as a serious medical condition where, for short periods of time, air cannot flow into or out of a sleeping person's nose or mouth. This occurs when the throat muscles and tongue relax during sleep or when overweight people have excess tissue in their throat and neck -- both causing partial blockage of the airway.

Sleep apnea sufferers can have 20 to 60 or more involuntary breathing pauses -- called apneic episodes -- per hour, each lasting 10 seconds or longer. People with sleep apnea usually snore between episodes, and then snort, gasp or choke when they start breathing again. Because their slumber is constantly disrupted, they are deprived of the deepest stages of sleep.

It can be dangerous

A study in the February 2000 issue of the Journal of the American College of Cardiology found that the 33 percent of 71,779 female nurses aged 40 through 65 who snored regularly were more at risk of developing cardiovascular disease than those who did not snore. The study, conducted over eight years, concluded that independent of smoking, weight, age and other cardiovascular risk factors, there was a "modest but significant increased risk of cardiovascular disease" in women who snored on a regular basis.

Because sleep apnea is twice as common in men, some doctors have overlooked the condition in women, according to Meir Kryger, M.D., director of the Sleep Disorders Center at the University of Manitoba in Winnipeg, Manitoba, and board member of the National Sleep Foundation. "Sleep apnea affects up to 2 percent of the female population, which is a lot," Kryger says.

Signs of sleep apnea

How can a woman tell if she has a sleeping disorder? One tip-off is the early onset of high blood pressure, also called hypertension. Kryger has seen patients in their teens with this condition. A 1999 study published in the American Journal of Epidemiology found that in 73,231 women aged 40 to 65, regular snoring was directly associated with hypertension.

Another sign of a sleeping disorder is something Pat Ternan knows well: feeling unrefreshed no matter how long you've slept. This sometimes results in a morning headache and daytime sleepiness. Often, a partner will notice that the snorer stops breathing for a moment, then gasps for breath as he or she starts in again.

A good night's sleep

After Pat Ternan recognized -- with the help of her husband -- that she had the signs of a sleep disorder, she was evaluated by a doctor at a sleep disorders center. She stayed overnight to have polysomnography -- a test that measures body functions, such as muscle tension and eye movement during sleep -- and was diagnosed with sleep apnea.

Pat now sleeps with the aid of a CPAP (continuous positive airway pressure) machine, thought to be the most effective treatment for sleep apnea, according to the National Sleep Foundation. She wears a sealed mask that fits over her nose, and the CPAP pumps air through her nasal passages, supplying continuous pressure that prevents Pat's throat muscles from collapsing during sleep. Her blood pressure has gone down, and she no longer experiences daytime sleepiness.

Besides the CPAP, other treatments for apnea include behavioral therapy (losing weight if needed, or avoiding alcohol, tobacco and sleeping pills) and surgery, although it's usually performed as a last resort, says Lewis Kline, M.D., director of the Sleep Center at the Western Pennsylvania Hospital in Pittsburgh. Surgery to treat sleep apnea can include the removal of the tonsils, uvula and excess throat tissues, Kline says, which increases the size of the airway.

As for Pat Ternan, she's thrilled that her CPAP machine has controlled her condition. "Before the machine, I would go to bed at 9 o'clock at night and sleep off and on until 8 o'clock in the morning, and I would get up and be absolutely exhausted. Now I'm much more alert, and I never sleep during the day. It makes all the difference in the world."

Because she's happier, her husband is also happier. "Before the sleep machine, she was run-down, tired, irritable, cranky, miserable," he remembers. And he's gotten used to the sound of the CPAP. "It makes a noise, but I would compare it to a humidifier running in the room." He much prefers it to the sound of his wife snoring.

© 2000 Healtheon/WebMD. All rights reserved.

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National Sleep Foundation
American Sleep Apnea Association
American Academy of Sleep Medicine

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