Plain old snoring can get a little annoying, especially for someone listening to it. But when a snorer repeatedly stops breathing for brief moments, it can lead to cardiovascular problems and potentially be life-threatening.
It’s a condition known as sleep apnea, in which the person may experience pauses in breathing five to 30 times per hour or more during sleep. These episodes wake the sleeper as he or she gasps for air. It prevents restful sleep and is associated with high blood pressure, arrhythmia, stroke and heart failure.
Heart disease is the leading cause of death in the United States, and stroke is also a leading cause of death and disability. High blood pressure is a major risk factor for both.
“The evidence is very strong for the relationship between sleep apnea and hypertension and cardiovascular disease generally, so people really need to know that,” said Donna Arnett, Ph.D., chair and professor of epidemiology at the School of Public Health at the University of Alabama at Birmingham and the incoming president of the American Heart Association.
A Common Problem
One in five adults suffers from at least mild sleep apnea, and it afflicts more men than women, Dr. Arnett said. The most common type is obstructive sleep apnea in which weight on the upper chest and neck contributes to blocking the flow of air. (Another type, called central sleep apnea, is far less prevalent.)
Obstructive sleep apnea (OSA) is associated with obesity, which is also a major risk factor for heart disease and stroke. Besides obesity contributing to sleep apnea, sleep deprivation caused by sleep apnea can, in an ongoing unhealthy cycle, lead to further obesity, Dr. Arnett explained. In OSA the upper airway closes off because the muscles that hold it open lose tone - the more weight, the more loss of tone and the more severe the sleep apnea. Each time the airway closes, there is a pause in breathing.
Another type of sleep apnea, called central sleep apnea (CSA), is far less prevalent.) In CSA the brain doesn’t send regular signals to the diaphragm to contract and expand. There is limited snoring with CSA, and it has been associated with brain stem stroke because the brain stem is where the impulse to breathe comes from.
Listen to Those Snoring Complaints
Often a roommate or sleeping partner of someone with sleep apnea notices it. “It’s really hard to detect if you live alone, unless you go through a sleep study,” Dr. Arnett said. People with sleep apnea may be more tired during the day, she said, and therefore prone to accidents or falling asleep.
Dr. Arnett told of her own family’s experience with sleep apnea. She accompanied her 73-year-old mother, Lela Arnett, on a trip to Germany and heard her make loud snorts during the night.
It got so noisy that Donna Arnett ended up sleeping in the hotel room’s bathroom with the door closed. It turns out her mother had sleep apnea and severe hypertension. Her mother knew she sometimes awoke when she took big breaths, but she didn’t realize the severity of what was happening.
Getting Proper Treatment
Through treatment known as continuous positive airway pressure, or CPAP, her mother’s blood pressure stabilized. The CPAP device involves wearing a mask while sleeping.
It keeps air pressure in the breathing passages so they don’t close down. Some patients have bad reactions to the masks, Dr. Arnett said, but their design has evolved significantly, making it easier to find a suitable one.
In a sleep study, doctors count pauses in breathing to determine whether the patient has mild sleep apnea, characterized by five to 15 episodes per hour; moderate sleep apnea, defined by 15 to 30 per hour; or severe sleep apnea, meaning more than 30 each hour.
It’s certainly possible to have simple, loud snoring without sleep apnea. But with regular snoring, the person continues to inhale and exhale.
With sleep apnea, the sleeping person tends to have periods when he or she stops breathing and nothing can be heard. The good news is treatment that keeps the breathing passages open and oxygen flowing can yield fast results, Dr. Arnett said. “Blood pressure comes down really quite quickly.”
Getting Good Rest
If you’re struggling to get a good night’s sleep follow some of these suggestions:
- Get regular physical activity, but don’t do it right before bed because that gets your adrenaline pumping and can keep you awake.
- Limit alcohol consumption to one drink per day for women and two drinks for men; too much alcohol interferes with sleep.
- Avoid caffeine before bed.
- Develop a pre-bedtime routine such as taking a warm bath, dimming the lights or having some herbal tea.