CC: Snoring: Can it KILL YOU?

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Your snoring. Could it kill you?

Today we're gonna talk about something really important, your snoring. Could it kill you? Good to know. Really, what we want to know is whether your snoring represents obstructive sleep apnea or if it's just a socially embarrassing problem that you have to contend with. So I thought I'd put together a list of ten different symptoms of obstructive sleep apnea, and that's what's going to follow. Enjoy.

The most common symptom of sleep apnea is snoring.

There are patients who have sleep apnea who do not snore, but as we focus on snoring, you need to understand that the sound generated represents turbulent airflow. What that means is that air does not smoothly flow through the nose, the back of the nose, the throat, and into the lungs. Instead, it hits levels of resistance. When it hits levels of resistance, it causes tissue to vibrate. The vibrating tissue generates snoring.

This picture demonstrates progressive decrease in airflow.

The middle picture demonstrates that air can flow through the nasal passageway mostly, and yet the patient will still snore and have sleep apnea. If you look carefully at this diagram, you will see that the tongue is pushed back towards the neck making for a very tight space. This also pushes the uvula posteriorly.

The lowest picture demonstrates that as air enters the nasal passageway, it has resistance. That is the curvy line. Also, air is flowing through the mouth.

One problem I have with these series of images is that, typically, patients will be moving most of their airflow through their mouth and not through their nasal airway, and therefore, there's even more turbulence by the time the air makes its way through the back of the throat.

If you sleep with your mouth open this sets up turbulent airflow from the outset so it is absolutely essential that you can breathe through your nasal airway if you hope to address snoring in a comprehensive manner. Please, take the time to look at the rest of the video content on the Modern Nose Clinic website. This will include other videos in the future including a dedicated video on the nasal airway.

We've discussed snoring. The second symptom of sleep apnea that some patients will demonstrate is choking or gasping while sleeping. Many patients will have sleep apnea, and they will not be aware of choking or gasping, but if you or a loved one has noticed choking or gasping while sleeping, this correlates significantly with sleep apnea. Please, discuss this with your physician.

The third symptom is an inability to fall asleep or remain asleep. While it is unclear why patients who have sleep apnea oftentimes struggle to fall asleep, oftentimes there can be an emotional component. There can be anxiety that, when you are sleeping, you will wake up gasping for breath. You may not be able to breathe well, and this can play into the anxiety and create a vicious cycle. This can lead to a difficult time initiating sleep.

Remaining asleep.

Patients will oftentimes believe that they have to wake up to go and urinate; they will do so frequently.  An experiment that I have run on several patients has shed some light on this matter. Certainly, there are patients who have problems with their prostate, etc. Also, there are many patients who find that when they measure how much urine they're producing when they go to the bathroom in the middle of the night, it is a relatively small quantity. My interpretation of this information is that the patient has been awoken because of their sleep apnea, and they are aware of some bladder issues. Sometimes, being rapidly taken out of your deep REM sleep with sleep apnea will cause loss of bladder control. This happens frequently in children; so for adults, they become aware of the need to urinate, they go to urinate, and it's really not that much urine being produced. So oftentimes, waking up frequently is the result of obstructive sleep apnea as opposed to a prostate problem.

The fourth symptom of obstructive sleep apnea we will call disturbed sleep or poor sleeping. Complex activities occur in the brain as patients sleep. These complex activities require cycling between deep REM sleep and other deep levels of sleep. Different hormones are secreted and different activities occur. When the patient does not cycle smoothly back and forth, the brain will not feel well rested. You will wake up exhausted even if you are sleeping an adequate number of hours. Patients who wake up in the morning still feeling exhausted even though they have slept enough hours of sleep correlate significantly with obstructive sleep apnea.

The fifth symptom of clinically significant obstructive sleep apnea may be frequently waking up with a sore throat. We touched on this earlier. Patients who sleep with her mouth open will dry out their throat; this will cause a dry or sore throat and requires reestablishing physiologic airflow. If your physician can help you to breathe better through your nose with your mouth closed, that would be beneficial.

The sixth symptom is weight gain. This is a very interesting topic for one reason. This gets back to the fact that the brain undertakes complex activities while sleeping. High-quality sleep generates correct hormone flow. When the patient is unable to have high-quality sleep, the body will secrete an increased amount of hormone called ghrelin (this is spelled G-H-R-E-L-I-N); this tells the body that it needs to eat. Th body will also secrete a decreased amount of hormone called leptin (this is spelled L-E-P-T-I-N); this tells the body to stop eating. Finally, a very important hormone that is disrupted with sleep apnea is insulin. When a patient is suffering from sleep deprivation, their body will become relatively insulin resistant. The body will react by producing more insulin, and this will cause the patient to crave unhealthy foods. So in summary, patients who suffer from weight gain may be doing so because of inability to get a good night's sleep.

The seventh symptom that we will discuss is feeling sleepy throughout the day. Even if you've had an adequate number of hours of sleep, you may not feel well rested. If you feel sleepy throughout the day, you need an extra cup of coffee, you just can't perform to the level you believe you should, you may be suffering from sleep apnea.

Forgetfulness.

When you are struggling to focus, you find yourself to be more scatterbrain; it's not as easy to remember or learn new complex tasks. You could be suffering from an inability to get a good night's sleep because of obstructive sleep apnea. There are complex processes that occur while you're sleeping that may lead to the development of Alzheimer's disease. This is beyond the scope of this particular talk, but I will do another talk in the future that focuses on that. So if you suffer from forgetfulness, this could be the result of obstructive sleep apnea.

Mood swings.

Patients who have obstructive sleep apnea will find that they are more irritable than normal. They may feel blue when there's no good reason to feel depressed. They can be more impatient than they normally are. If you notice these behavior changes, consider the possibility that you may be suffering from obstructive sleep apnea.

Lack of interest in sex.

Patients who have obstructive sleep apnea will not secrete testosterone during sleep as they should. This impacts both males and females where they will experience decreased libido. For males, they could suffer from erectile dysfunction as the result of obstructive sleep apnea. For women, they can experience decreased sexual sensation and decreased desire.

Other symptoms that can occur from obstructive sleep apnea include headaches. Patients who wake up in the morning with headaches or experience increasing frequency may be suffering from obstructive sleep apnea.

Dental grinding.

This is highly consistent with sleep apnea. This patient demonstrates the lower teeth that have a white circumferential area which represents enamel. The inside portion, which is typically darker, is the tender dentin. If you look to the upper teeth, you can see how there is thinness along the lower edge. Looking inside the mouth and upwards will demonstrate that you are wearing down your teeth from the inside. This is another piece of information that would suggest possible sleep apnea.

So the purpose of taking the time to make these videos is that, at the Modern Nose Clinic, we want to extend the patient experience. We'd like it to start before you come to visit us. Perhaps your primary care doctor suggested, "Take a look at these videos." We'd like them to continue. When you get home after your appointment, you can review this with your spouse, and you could review this just yourself to see whether or not any of this makes more sense. If you have questions just give us a call. Thanks again Doug Skarada. The Modern Nose Clinic.

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