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By Dr Ong Chun Chiang
Snoring is a harsh sound generated by turbulence of airflow during sleep. All of us have experienced or heard other people snore at one time or another in our lives. It can occur in those who are very tired or those who had a few drinks of alcohol.
However, it is not normal to snore on a regular basis. It is estimated that up to 35% of men and 28% of women snore frequently. Overweight people are more likely to do so.
Snoring seems to be a taboo subject in our society. Nobody seems to want to talk about it. Usually, there is strong denial in someone who snores. When confronted by their sleeping partners, they often brush it aside as if it is a small matter. Some snore so loudly that even their neighbours could hear them. It is the sleeping partner who has to put up with the loud noise throughout the night.
Snorers do not get good sleep. They often wake up in the morning feeling tired, as if they had not had enough sleep. The main worry about snorers is the fact that they could be suffering from obstructive sleep apnoea.
The term “apnoea” literally means “to stop breathing”. Sleep apnoea occurs when one stops breathing for a short moment during sleep. There are two main types, namely central sleep apnoea and obstructive sleep apnoea.
Central sleep apnoea occurs when part of the brain that regulates breathing during sleep becomes defective. A tumour in the brain, stroke, toxicity due to certain drugs, head injury and certain brain disorders can cause this. Fortunately, central sleep apnoea is rare.
Obstructive sleep apnoea, as the name implies, is caused by obstruction to the airflow during sleep. This often presents as loud snoring followed by episodes of obstruction whereby one gasps for air. Sufferers tend to be lethargic during the day, lack concentration at work, irritable and have a tendency to fall asleep while reading or watching television. If left untreated, obstructive sleep apnoea can lead to multiple social and medical conditions. Daytime sleepiness can lead to accidents on the road and at work. Sufferers are often forgetful and have poor relationships with their partners and work colleagues.
Medical conditions that can arise include pulmonary hypertension (high blood pressure within the lungs), high blood pressure, congestive cardiac failure, ischaemic heart disease, heart attack and even stroke. An American study showed increased risk of blood clot in the hearts and brains of people with sleep disruptions.
It has been shown that more than 50% of overweight people (more than 15% of their ideal body weight) suffer from obstructive sleep apnoea. All in all, 4% of working men and 2% of working women are believed to be suffering from this condition. Asians have been found to have higher incidence. 21% of Malaysians could be suffering from obstructive sleep apnoea without even realising it.
If there is suspicion of obstructive sleep apnoea, one can undergo polysomnography or a sleep study test to confirm. In the past, one had to be admitted to a sleep laboratory in a hospital to have this test. Nowadays, a technician can come to the house to have the test equipment wired to the person before he or she goes to sleep. The technician will collect the equipment in the morning after overnight recording. In this way, the test is more accurate as the person sleeps in his or her normal bed and in his/her usual environment as opposed to a strange environment in the hospital.
A polysomnography can confirm the diagnosis of obstructive sleep apnoea and its severity. Depending on the severity and sites of obstruction, this condition can be treated either using nasal CPAP (continuous positive airway pressure) or by surgery.
Nasal CPAP is a machine that sufferers wear each night during sleep. This machine ejects air into a mask that sufferers wear. By doing that, enough oxygen is inhaled by the sufferer during the night that prevents complications of obstructive sleep apnoea. However, not every sufferer finds this machine comfortable. Some develop dryness of the nose and throat and others could not get used to fitting a mask on their face during sleep.
Operations can improve or cure obstructive sleep apnoea. However, the types of operation required are different for different sufferers.
Uvulopalatopharyngoplasty (UPPP) is a useful operation for sufferers whose obstruction are at the level of soft palate and uvula. The new much publicised pillar implant procedure can also achieve this. More drastic operations such as genioglossus advancement, hyoid advancement and maxillomandibular advancement are rarely performed, with varying success.
Sometimes, a tracheostomy (bypassing the obstruction by making a hole in the windpipe) is carried out.
Children too may suffer from obstructive sleep apnoea. Many of them can be treated by removing their tonsils and adenoids. A few of them require more drastic interventions like those of adults.
Most importantly, snoring and obstructive sleep apnoea in the majority of cases are preventable. A well balanced diet plus regular exercise combined with a healthy lifestyle are all one requires. If in doubt, one ought to consult a specialist.
The following websites are useful for additional information:
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