Heavy snoring can sound funny to your sleep partner and annoy them terribly, but it is no joke. It is often the sign of a condition called obstructive sleep apnea, which we now know raises the risk for diabetes, obesity, hypertension, strokes, heart attacks and other cardiovascular problems.
People with obstructive sleep apnea stop breathing for 10-20 seconds while they sleep, and this can occur from a few to hundreds of time a night. Snoring doesn’t occur in every case of sleep apnea, and all people who snore don’t have sleep apnea, but anyone who is told they snore should consider obstructive sleep apnea as a possible cause.
Snoring is caused by the tongue not having enough room in the back of the throat, particularly in those people who are obese, in heart failure, or sleep on their back. There are chemicals in the brain whose job is to trigger breathing, and these can fail in some persons who snore. As a result, oxygen levels drop dramatically and cortisone, adrenaline and other hormones surge.
These hormones contribute to high blood pressure, irregularities of the heart and can cause or exacerbate heart failure, trigger heart attacks, even sudden death. Even without snoring, people with obstructive sleep apnea have reduced oxygen in their system that can damage the heart.
We once thought obstructive sleep apnea was a disease of the obese, but we now know this isn’t true. While some people who are obese may have sleep apnea, other risk groups include:·
- People who use alcohol or sleeping pills
- Someone with diabetes
- Those with congestive heart failure
- People who are in their 50s and 60s
- Men more than women
As more people age, develop hypertension, diabetes or metabolic syndrome (pre-diabetes), the number of people with obstructive sleep apnea grows, which is very concerning to health providers. People with this condition generally understand it is bad for their heart health, so it is easier today to successfully encourage patients to see a sleep specialist than it once was.
Symptoms for the condition include:
- Daytime sleepiness, fatigue, or needing a nap
- Falling asleep or being drowsy at odd times such as while driving or watching TV
- Snoring at night
- Waking up suddenly from sleep gasping or chocking for no apparent reason
- Waking with a dry or sore throat
- Inability to pay attention when needed
- Not feeling refreshed in the morning
- Waking with a headache
- Choking on acid reflux during the night
- Atrial fibrillation, a type of irregular heart beat that can increase the risk for stroke or heart failure
Although obstructive sleep apnea is a very serious medical condition, it is treatable. Weight loss is an important tool. A very effective treatment—one that helps 90% of those who are compliant with the method—is using a Continuous Positive Airway Pressure device, or CPAP. Its mask creates pressure in the airway that prevents snoring and the apnea.
The new models are smaller and easier to use. People with simple snoring that isn’t very loud and without any other symptoms can usually handle things by sleeping on their side and, if indicated, lose some excess weight.
There are a number of other important benefits to treating sleep apnea, particularly in people with congestive heart failure. Patients with heart failure are highly likely to have sleep apnea which worsens the heart failure and further reduces the heart pumping function. Treatment with CPAP can improve the heart pumping function by as much as 50%. In men and women with obstructive sleep apnea, CPAP can help prevent or reduce the frequency of atrial fibrillation and other irregularities of the heart.
If you suspect you have sleep apnea, talk to your family doctor. Our own health system offers comprehensive sleep-related diagnosis and care; see http://www.uofmhealth.org/medical-services/sleepmedicine for information on locations and services.”
Melvyn Rubenfire, MD, FACC, FAHA, is a professor of internal medicine and director of Preventive Cardiology at the University of Michigan. He is a pioneer in coronary disease prevention and is responsible for developing Pulmonary Hypertension, Lipid Management and the Metabolic Fitness Programs at the U-M.
The University of Michigan Samuel and Jean Frankel Cardiovascular Center is the top-ranked heart and heart surgery program among Michigan hospitals. To learn more, visit our website at umcvc.org.