Sleep Apnea: More Than Simple Snoring

POSTED: July 22, 2007 2:21 pm

Unlike short-term sleeplessness, chronic insomnia is often a symptom of a serious underlying medical disorder. Depression and other psychiatric disorders account for many cases of insomnia, as do wholly physical illnesses, such as asthma, arthritis, Parkinson's disease, kidney or heart disease, and hyperthyroidism.

Sleep apnea is among the most common and most dangerous types of sleep disorder. An estimated 18 million Americans have the condition, which is marked by repeated episodes of cessation of breathing during sleep that over time can lead to high blood pressure, cardiac disease, and disordered thinking.

Sleep apnea was the culprit in Lauren Ero's case. After two years of trying various antidepressants that offered her no relief, Ero sought a second medical opinion and was sent for a sleep analysis.

"Then it was really obvious what it was," says Ero, who recently began working for the American Sleep Apnea Association. "It was a classic case."

The tests revealed what Ero didn't know and what her husband hadn't found alarming: Ero was snoring. But her "snoring" problem was distinct from the merely annoying type because she was also gasping for air throughout the night--possibly tens of times each hour--which repeatedly roused her out of her refreshing, deep sleep. The results were the telltale signs of sleep apnea: excessive daytime sleepiness and difficulty functioning.

Breathing is interrupted when air can't flow into or out of the nose or mouth. The reason for the blockage could be an over-relaxation of the throat muscles and tongue, which partially blocks the airway or, in obese people, an excess amount of tissue in the airway. Those with receding chin lines are also at higher risk for developing obstructive sleep apnea.

In the less common form, central sleep apnea, breathing is stopped not because the airway is closed but because the diaphragm and chest muscles stop working.

Mild cases of obstructive sleep apnea can sometimes be treated by making simple behavioral changes, such as avoiding alcohol, tobacco, and sleeping pills; losing weight; and sleeping on one's side. Also, oral devices to prevent obstruction of the airway by holding the tongue or jaw forward may help with mild cases.

The most common effective treatment for obstructive sleep apnea is nasal continuous positive airway pressure, or CPAP. The patient wears a soft plastic mask over his or her nose while sleeping. A device supplies pressurized room air through a flexible tube attached to the mask. The pressurized air acts as a splint to prevent the airway from collapsing.

"You have to get used to wearing a mask while you sleep," says Ero, who has been using the CPAP device nightly since 1996. "But you feel so much better, it's worth the hassle. Within two weeks after starting to use it, I felt like a different person. I have so much energy now."

Surgery to increase the size of the airway is another possible option for sleep apnea treatment. The removal of adenoids and tonsils, especially in children, or other growths or tissue in the airway is sometimes effective, as are other, relatively more risky surgical procedures, including uvulopalatopharyngoplasty (shaving of the excess soft tissues in the mouth and throat) and tracheotomy (creating an opening in the neck through the windpipe) for the most severe cases.

The newest device for this condition is Somnoplasty, used to treat mild cases of sleep apnea. It is a radio frequency surgical device that shrinks the soft palate in a half-hour outpatient procedure. FDA approved the Somnoplasty device in July 1997.