Sunday 18 February 2018

Ask the doctor: health risks associated with snoring

Snoring: picture posed
Snoring: picture posed

Dr Nina Byrnes

I'm really worried about my husband – he snores every night. It's so bad that at times he sounds like he might choke or he stops breathing. He tells me I have nothing to worry about but I don't think this can be good for his health. What do you think?

Dr Nina says: Snoring is a very common condition. It most commonly affects people aged between 40 and 60 and is twice as common in men as in women. It occurs when the soft tissue at the back of the mouth or throat becomes floppy and vibrates when a person breathes.

There are various grades of snoring.

Grade 1 is fairly quiet and intermittent and doesn't lead to any altered sleep of the person who snores but may disrupt that of their partner! It is not associated with any health complications.

Grade 2 snoring is snoring that occurs on more than three nights a week, is quite loud and may result in some breathing difficulties due to narrowing of the upper airway. This may disrupt sleep somewhat and can lead to the person affected feeling tired the next day.

Grade 3 snoring occurs every night, is loud and may be heard from another room. This grade of snoring is commonly associated with a condition called Obstructive Sleep Apnoea (OSA), which does indeed have long-term implications for an individual's health.

It is estimated that 4pc of middle-aged men and 2pc of middle-aged women suffer from OSA.

When we sleep, the muscles in our throat become more floppy. In most people this is not a problem, however in those with OSA the muscles are so floppy that they cause the airway to narrow or collapse completely. This blocks off the airway causing breathing to stop (apnoea) or episodes of very shallow breathing (hypopnoea).

These episodes usually only last seconds but the reduction in air flow leads to a fall in oxygen levels in the blood. The brain responds by increasing the effort to breathe usually causing the person to gasp, grunt or wake briefly. The person then settles back to sleep and the cycle starts again. We all have occasional episodes of apnoea but if these episodes are occurring more than five times an hour, then OSA is the likely cause.

Many people who suffer from OSA are unaware that they are not sleeping well. They don't recall the frequent night time waking but their partners are usually very aware of the problem. Those with OSA often feel tired or drained during the day. People with severe symptoms may fall asleep during daily activities such as driving or operating machinery. This can have serious implications. The risk of car crash is increased by 7-12pc.

Other symptoms include poor concentration or irritability, morning headaches, unrefreshing sleep and depression. The recurrent episodes of low oxygen cause increased release of stress hormones. This ultimately puts a strain on the heart, leading to a significantly increased risk of high blood pressure, stroke, heart attack, and even heart failure. There is also a link between OSA and diabetes.

Factors that increase the risk of OSA include being obese, smoking, drinking alcohol in the evening, taking medication that makes you sleepy, sleeping on your back and having enlarged tonsils or a receding jaw. The risk increases to about 10pc in those over the age of 65 and it can run in families.

OSA is diagnosed via a sleep study. This involves attending a specialist unit where you stay overnight and your sleep is monitored. The amount of episodes of reduced or absent breathing can be recorded along with levels of oxygen and blood pressure, heart rate etc.

Once a diagnosis is made, the most common treatment for OSA is CPAP (Continuous Positive Airway Pressure). This involves wearing a special mask at night that is connected to a machine emitting air. This airflow keeps the airway open, thus maintaining normal breathing, airflow and oxygen levels. The result can be life-transforming.

Lifestyle modification, however, also plays a very important part in the treatment and should not be forgotten. It is essential to lose weight, avoid alcohol for four to six hours before bed, avoid sedatives, sleep on your side (special pillows can help) and stop smoking.

It sounds to me like your husband may suffer from OSA. The grunting sounds at night are very typical of this. You may also notice that he complains of feeling tired a lot or dozes off in the chair during the day or evening.

I would advise him to go along and discuss it with your GP as not only will treatment help him feel better but due to the many associated health risks it could actually save his life.

Health & Living

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