Greg has snored loudly most of his life. About three years ago, when he was 49, he realised he was probably also suffering from obstructive sleep apnoea (OSA), which is characterised by brief interruptions of breathing during sleep, followed by a gasp for a breath for air. He was always tired during the day.
“I would snore loudly, then stop breathing, then gasp loudly to start breathing again,” he says.
“It was affecting my daily life badly both at home and work. I used to drive to Durban at weekends, but because I would get so tired and sleepy it was too dangerous and was no longer an option.”
Kgomotso says she knew about her snoring, but did not know how severe it was until she had a sleep study.
“The results showed that while I did not have OSA, I do snore like a lion when I lie on my back, and it’s waking me up. I am now trying to train myself not to sleep on my back, with little success,” she says.
Habitual loud snoring is a major symptom of OSA – although not all snorers have OSA – says Dr Dave Koton, of the Snore and Sleep Apnoea Centre in Rosebank.
Studies have shown that 45 percent of men and 35 percent of women snore. The percentage increases with age, and figures in the US show that 40 percent of people aged 40 snore. Among 60-year-olds, 60 percent snore.
Snoring occurs when turbulent airflow causes the soft tissues at the back of the throat to vibrate during rapid eye movement sleep. During this stage of sleep the lower jaw will fall back, as will the soft tissue at the back of the throat (soft palate). This will cause the tongue to fall back as well. There is now a blockage at the back of the throat closing the airway.
“Excess carbon dioxide cannot be breathed out and accumulates in the blood, which is now detected by the brain as a danger. This sets up a reaction in which the respiratory muscles are forced to breathe in at a greater velocity, causing a vibration of the soft palate or snoring,” explains Koton.
The severity of snoring can be affected by being overweight or on medications such as antihistamines or sleeping pills.
Alcohol also increases snoring as it is a muscle relaxant.
Koton says snoring can take a heavy toll on people’s lifestyles.
“Marriages have broken up over one partner snoring, while the other ends up sleeping in the spare bedroom. Neither person has sufficient sleep, so they are both tired and irritable the next day. It also affects work productivity.”
Domenico readily acknowledges his snoring is causing tension in his marriage. “If there’s a cure, it may help avoid divorce on account of my nocturnal whale blowhole emulations and other audio effects,” he says.
People who snore should be evaluated to be sure they do not have some form of apnoea as this may be a potentially dangerous condition, warns Koton.
“If you are constantly struggling for breath while you sleep and sleeping fitfully, aside from feeling tired in the day, you may wake up with a headache, and your concentration may be so impaired you may even falling asleep at the wheel while driving,” he says.
In the US a study was done on the number of heavy haulage drivers who had accidents in the afternoon. Many blamed this on lack of sleep because of parties at their overnight stops.
However, when a polysomnograph (sleep study test) was done on these drivers, it was found that they all had a sleep deprivation disease like OSA, causing a lack of oxygen and sleepiness at the wheel.
When Aly moved in with her boyfriend, she was frightened by his apnoea episodes.
“On the second night, he continually stopped breathing. I thought he was having some type of attack, so I called in a doctor.”
She was right to worry, because studies have shown that dangerously low levels of oxygen are also implicated in increased blood pressure, stroke, heart conditions, loss of libido and diabetes type II.
When you go for a polysomnograph you will be required to fill in an Epworth Sleepiness Test questionnaire, which is your assessment of how sleepy you become during the day.
This scale gives an indication of your sleep apnoea severity, depending on the score.
Sleep apnoea can be mild, moderate or severe. The polysomnograph measures your physiological sleep process, which may be recorded in a clinic or at home.
Koton says that over-the-counter remedies for snoring, like pillows, throat sprays, and boil and bite mouth guards are gimmicky and do not work.
“What does have good results is an oral appliance which is custom-made for you. It consists of two transparent splints which hold the lower jaw in position so it cannot fall back,” he says.
Clinical tests have shown that the appliance can reduce snoring by 90 percent or more, and apnoea by up to 50 percent or more.
For Greg, it was the answer to his problem. “Ever since I got the appliance about a year ago, I have slept well and I am no longer tired during the day. My wife can hardly hear me snoring and I no longer gasp for breath,” he says.
For Derek, who is overweight, it was estimated by Koton that it would be about 70 percent successful, but according to his wife, it has been 99 percent successful.
For severe sleep apnoea, the most effective treatment is a CPAP (continuous positive air pressure) machine.
It has a mask which is worn over the nose while sleeping, providing oxygen and allowing the person to breathe normally.
“The problem is only 40 to 50 percent of patients are amenable to wearing the mask as it is noisy, and the tube and mask make it uncomfortable to wear. But those patients who do comply with it are much better off, not only waking refreshed, but averting associated medical conditions,” says Koton.
Mild to moderate sleep apnoea can be treated with an oral appliance. This treatment is recognised by the American Academy of Sleep Medicine, and the American Academy of Dental Sleep Medicine.
If you are not amenable to using a CPAP, then an oral appliance is recommended aid. - The Star
l The Snore and Sleep Apnoea Centre – call 011 788 5305 or visit the website www.sleepmedicine.co.za
* Names have been changed.