WHAT IS YOUR SNORE SCORE?

(Originally published in Sarasota's Natural Awakenings magazine June 2011)

What is your Snore Score?  Anyone ever tell you that you were “sawing logs?”  Ever wake to the sound of your own snoring?  Nobody loves snoring and now we know it poses a true danger to health.

                As we age, the tissues of the uvula and soft palate of the throat can lose their tightness, causing obstructive sleep apnea or OSA.  From the Greek, apnea means “without breath.”  During sleep, this throat weakness can cause the throat to close, blocking the breathing passageway- a moment later- a gasp is heard as the breath is restored. Repetition of this is the snoring one hears, soft or loud, it’s still snoring. More than 24% of men over age 40 snore and likely have sleep apnea or OSA, which accounts for 85% of all apnea. Just poking the snorer awake or rolling on your side doesn’t solve the problem even if it stops the snoring for a little while.

                The risk is much greater than simple sleep deprivation.  Irritability, lack of focus and concentration, day time sleepiness and decreased libido are the mild consequences of apnea.  The real dangers are diabetes, hypertension and fatty liver (NASH- Non-Alcoholic  Steato-Hepatitis).  Add those to a 34% increase in risk of heart attack and 67% increase in risk of stroke and suddenly snoring is more than just annoying!

It was only a few years ago that Swiss researchers found a connection between liver disease occurring in people who drank no alcohol and low blood oxygen. “Hypoxia (lack of oxygen) may be the link leading to accumulation of fat in the liver and progresses to NASH according to lead researcher, Dr. Pignet of University of Bern as published in Clinical Science.

Being male, over 40, obese, having large tonsils, sleeping on your back, relaxant drugs or alcohol and poorly positioned jaw (often due to muscle tension) are all contributors to apnea. But thin women can have apnea, too.  Don’t exclude yourself if you snore just because you’re not overweight or male.  Ask your doctor for an oxymetry test.

Humans don’t store oxygen. You can go a month without food, a week without water and 3-4 minutes without air. Guess what’s most important for survival?  Most people can only hold their breath voluntarily for 1-2 minutes. Prolonged apnea ultimately leads to severe deficiency of blood oxygen.  This affects energy, mental clarity and even risk of cancers.  Death ensues in minutes without life giving breath.

Sleep studies called oxymetry tests determine if apnea is indeed happening. A simple device clipped onto the finger overnight and attached to a wrist band computer are all that’s needed to find out if someone “desaturates” or drops their blood oxygen too low repeatedly during the night. More complex sleep studies are done in a sleep lab to differentiate obstructive apnea from central or mixed apnea, which are more complex.  Central apnea comes from poor breathing signals from the brain, not simple obstruction and affects only .4% of apnea sufferers.  The balance of sufferers, nearly 15%, is mixed apnea types.  

Now that the development of diabetes has been linked to apnea, a “chicken & egg” question appears.  Does the apnea cause the diabetes or does the diabetes cause apnea?  Since diabetes progresses heart disease by 400%, it is linear logic to connect apnea to diabetes to heart attack or stroke.  Yikes!

Treatments all involve clearing the air passageway through the throat. Losing weight, elevating the head of the bed 30%, sleeping on your side, using nose clips and nasal sprays all create some benefit.  Best of the treatment thus far is the CPAP (Continuous Positive Airway Pressure) treatment where a plastic mask is worn attached by a flexible hose to an air pump to provide, as the name implies, continuous pressure to the airway. Other than just getting used to it, it can relieve symptoms from the very first night.

Obviously, removing enlarged tonsils would be appropriate as a surgical intervention if needed. Surgery to permanently remove the loose tissue in the throat is successful 90% of the time, but is highly invasive and miserably uncomfortable. Ablation techniques using radio frequency is a newer strategy that avoids scar tissue and thus the risk of further reducing the airway.

The best novel treatment for snoring is learning to play the Australian Aborigine musical instrument- the didgeridoo.  Apparently, the muscles of the throat tighten with the regular practicing of this ancient instrument.  You can stop snoring and entertain the neighborhood.

Infomercial television periodically has a new spray, pill or device which claims relief from snoring.  But, alas, claims don’t tighten tissue.  Many dentists custom design “night splints” or retainers that change the way teeth meet by thrusting the jaw forward.  These expensive mouth guards do work for some people to reposition the soft palate upward so the air passageway is more open.

Only an oxymetry test can confirm apnea, so if you are snoring, this action is the next step to reduce your risk of major health issues.  Abnormal liver enzymes (SGOT & SPGT, also referred to as ALT & AST) call for investigation. Are statin drugs, alcohol or hepatitis causing high liver enzymes?  Or is it snoring causing NASH?  The best news of all is that if the apnea stops, the risks decline, plus you’ll feel better, more rested, brighter and refreshed.  Still, it will only be a matter of time until there are CPAP machines for snoring dogs too.