Every one of us must have met people who snore, could be parents, spouse, relatives, friends, children, or strangers. 20% of the adult population and 60% of men above 40 years are affected by snoring. Some people have a light snore while others might be loud enough to disrupt others sleep. A story of a Japanese couple who parted on the grounds of the husband’s snoring issue was in highlight a while back, it is said that sleep medicine was born in Japan to save relations more than lives. Keeping the tales aside, snoring is not just a social stigma, it is a medical problem.
A most common myth in India about snoring is that it is a sign of sound sleep, the truth is vice versa, snoring is a sign of restless sleep. Snore is the sound of the throat tissue vibrating from the inhales of air during breathing. It occurs due to the narrowing of the upper airways, especially at the oropharyngeal lumen. As soon as the patient falls asleep, the tone of the soft palate and tongue decreases, this leads to falling back of the tongue or soft palate due to negative pressure generated during inspiration leading to luminal narrowing. This can be further accentuated by narrowed lumen due to fat deposits around the oropharynx as in obese people or those who have small and retrognathic mandibles.
Obesity is observed to be one of the important reasons for snoring. Occasional snoring could be due to a tiresome day or drinking alcohol, but a regular snoring episode might be hiding serious sleep disorders. If the luminal narrowing is not severe, the snore would cause disturbance to the sleep of the bedpartner. However, if the luminal narrowing is significant, besides snoring the person develops reduced breathing called hypopnea and if the lumen completely collapses it leads to obstruction of breathing called apnea. Both hypopnea and apnea, if they last beyond 10 seconds can lead to a fall in oxygen in the body and thereby disrupt sleep. This leads to frequent awakening, the tone of the muscles increases, and the lumen opens leading to snoring. But simultaneously they will also have a sudden rise in blood pressure and heart rate. Although, this is a defence mechanism, in the long run is hazardous to life. If not treated, sleep disruption and oxygen desaturation occur every night multiple times. And over a period, the patient will start experiencing various medical problems.
Multiple awakenings and desaturation every night is obstructive sleep apnea. Some common symptoms of obstructive sleep apnea could be a restless night leading to a sleepy day, frequent micturition at night, early morning headache, lethargy, memory impairment, and loss of libido. The risk involved with this disorder can be understood by the fact that OSA is the second most common cause of the road-traffic accidents in US and drivers are not allowed to renew or issue a driving license if they suffer from this disease unless they are treated for it. Obstructive sleep apnea is also an independent risk factor for hypertension, diabetes mellitus, coronary artery disease and sudden cardiac death. If OSA remains untreated they produce pulmonary hypertension and right heart failure.
About half of the people who have snoring issues suffer from OSA. Early diagnosis and treatment of OSA is not only marriage-saving but also lifesaving. Any person who snores and has the symptoms mentioned above must undergo an overnight sleep study. The sleep study can be done at home or in the sleep laboratory at a hospital. Those who suffer from OSA are advised to lose weight as well as undergo a thorough investigation to identify the site of obstruction which can be surgically corrected if feasible. However, most of them might have to use a CPAP machine while sleeping. CPAP prevents narrowing of the oropharynx by giving continuous positive pressure during sleep. This leads to good and sound sleep without snoring and a better quality of life. Therefore, snoring is not a sign of good sleep. Beware and be alert!!
Dr. Dipesh Maskey, Senior Consultant – Pulmonology, MMI Narayana Superspeciality Hospital, Raipur