According to the insomnia, nocturnal respiratory disorders constitute a separate form of sleep disorder. Sleep apnea is far more consequential to health than normal snoring.
Snoring: Not only robs the sleeper from sleep
The nocturnal snoring concert usually arouses only the bed neighbors. The snorer himself does not usually or rarely perceives it. As you sleep, the muscles in the pharynx become slacker, soft parts of the palate begin to vibrate in the breeze of the breath. They also narrow the airways, especially in the supine position, when the base of the tongue falls back. This reinforces the noise problem.
Enlarged pharyngeal tonsil, jaw malposition’s are among the anatomical causes. Obesity also promotes the loud breathing technique when fatty deposits in the tongue, throat and neck area change the spatial relationships of the upper airways. Further reasons for nocturnal sawing concerts are impaired nasal breathing due to infections as well as chronic sinusitis. Alcohol makes muscles slacken, coffee or smoking swells up the mucous membranes at night. Breathing is correspondingly difficult and noisy. In old age, the muscles in pharynx weaker. That’s why older people snore more often. Most affected are men over 50 years.
Symptoms: Often, snoring does not significantly affect the sleep quality of the snorer himself. Except his bed partner awaken him again and again. It can also happen that he hears his sawing in sleep subliminal and thus awake briefly without being aware of it. The snorer then says that he has slept well, but feels tired, chipped and underachieving during the day. Even a dry mouth in the morning can be a clue.
Diagnosis: Diagnosis includes the report of bed partner. Here it is important for the doctor to distinguish annoying but harmless snoring from nocturnal pauses in breathing. Medical history and physical examinations give further indications, especially on risk factors for sleep apnea.
Therapy: There are many tips and tricks against the unwanted disruptive sounds, such as how the snorer avoids being supine. If anatomical peculiarities such as excessive tonsils or jaw problems are present, the doctor and patient may consider whether they should not be treated anyway. Here is an ear, nose and throat doctor or an orthodontist asked. Also, surgery on the soft palate may be indicated, but only if special anatomical conditions exist. Chronic sinusitis will be assessed by the ENT specialist and recommended for appropriate treatment.
Usually, however, there are general measures that a snorer can take to create more nocturnal rest: lose weight if you are overweight, if possible avoid alcohol, do not smoke, drink a little coffee. And: sleep enough. Because who is tired, snores more often. There are also special nasal patches or nose spreaders that sometimes facilitate breathing.
Sleep apnea: When breathing stops during sleep
Violent, irregular snoring may, however, be a sign of a serious nocturnal breathing disorder, for sleep apnea (Greek apnoia = breathlessness). Physicians speak of sleep apnea syndrome, because here several disease factors interact. The pharyngeal and pharyngeal muscles relax much more during sleep than during normal snoring.
In the most dangerous and common form of respiratory disorder, obstructive sleep apnea, they block the upper airways almost completely, so that the breathing air can’t go through for a short time. It comes to respiratory arrest. As a result, the oxygen content in the blood decreases, the carbon dioxide concentration increases. Increasingly, stress hormones are being released. All of this affects other organ functions such as the heart and circulation or the lungs. Finally, with the help of the respiratory muscles of the chest, abdomen and diaphragm, the affected person succeeds, sometimes with considerable effort, in opening the displaced airways from below by means of air pressure. The sleeper gasps, snoring loudly.
After a short recovery, the cycle starts again. The heart has to do more work, the blood pressure rises. Also increases the risk of diabetes mellitus. The quality of the individual sleep phases changes, the sleep becomes more superficial overall, the sleeper wakes up again and again through the respiratory distress, usually without even noticing it.
There is a close correlation between sleep apnea and cardiovascular diseases, respiratory diseases, strokes and depression. For example, heart patients often suffer from sleep apnea, while sleep apnea patients are more at risk of developing heart disease. In addition, risk factors are obesity – most commonly overweight men between the ages of 40 and 65 are affected by the disease – enlarged tonsils, tumors in the nasopharynx, narrow jaws. Alcohol as well as sleeping pills and sedatives increase the problem.
Symptoms: Very loud snoring that changes with breathing pauses and heavy breaths. The respiratory arrest may occur five to ten times and more in one hour and last for ten seconds or more. The sleeper himself usually does not notice the nocturnal episodes, but often develops an excessive need for sleep (hypersomnia) and feels tired during the day, chipped off and with only limited capacity. The pronounced daytime sleepiness considerably increases the risk of accidents. Accompanying symptoms include high blood pressure, cardiac arrhythmia, headache, heartburn, depression, anxiety. Breathing misfires and snorting without snoring are characteristic of the so-called central sleep apnea.
Diagnosis: Only in certain forms of sleep apnea, those affected by their shortness of breath wake up and consciously perceive them. For most it is the daytime symptoms that cause the doctor to suspect sleep apnea. Particularly important here are the information of the partner.
If necessary, an ear, nose and throat doctor will check if the upper airways are narrowed. Occasionally, an examination may be indicated by a sleep-medical-trained dentist, orthodontist or oral-maxillofacial surgeon including x-ray of the facial skull. If there is a suspicion of a disease of respiratory organs such as the heart, lungs and nervous system, investigations in this direction are appropriate.
If there is an urgent suspicion of a sleep apnea syndrome, measurements with a polygraph device for the home that the person affixes to at night may be effective. Otherwise, an examination in the sleep laboratory will ensure the diagnosis.
Therapy: Each treatment initially includes basic measures that affect lifestyle and sleep habits. Often changes in these areas already help to improve a slight sleep apnea. In the first place, it means for people with obesity to lose weight. Since alcohol and sleeping pills dampen the respiratory activity at night, the affected persons refrain from doing so better. This also applies to smoking.
In addition, it makes sense not to sleep on your back if possible. It often helps to sew a small ball, a raised foam part or similar in the back of the pajamas. The pressure automatically forces the sleeper back to its side position. Sometimes special bite splints help to increase the breathing space.
If such measures do not help alone in the case of more severe clinical pictures, ventilation therapy can counteract the respiratory disorder. In most cases, so-called positive pressure ventilation (CPAP stands for Continuous Positive Airway Pressure) is used. The sleeper wears a small breathing mask attached to a compressor on the bedside table. At night, the air flows at slightly elevated pressure into the airways, which remain open in this way. According to studies, the symptoms such as daytime tiredness, depression or hypertension improve rapidly and sustainably with CPAP breathing.
Essential: The affected person breathes in this form of ventilation therapy itself. Most of the therapy is designed as a long-term treatment, especially in the forms of obstructive sleep apnea, which are not otherwise treatable. This means, for example, that those affected use their CPAP device continuously, for example when traveling. There are also other forms of pressure ventilation.
If necessary, the doctor will specifically treat existing underlying or secondary diseases of sleep apnea, such as cardiovascular problems or diabetes.
Surgical measures are only indicated and successful in the case of nocturnal respiratory disorders if there are special deformities in the jaw-throat area.