PRESCRIPTIONS
Snoring may indicate sleep apnea
By Landis Lum
Q. My husband snores so badly! Is there anything to worry about?
A. If he has daytime sleepiness, his snoring may actually lead to strokes, heart failure, high blood pressure and even car accidents! How can you be sure? Get his doctor to order an overnight sleep study, which will tell whether he has something called sleep apnea, leading him to stop breathing repeatedly throughout the night (for 10 seconds to three minutes), causing frequent near-awakenings and low blood oxygen levels.
If he does have sleep apnea, his doctor will likely treat him with a mask connected to a device which allows him to exhale against a slight amount of air pressure (CPAP, or continuous positive airway pressure), reducing snoring, daytime drowsiness and his risk of a car crash. (Those nose-clip devices you see advertised don't really work.)
However, some people can't tolerate CPAP. In the past, I'd refer such patients for surgery, removing the uvula and a ring of tissue at the back of the throat. However, surgery can cause pain, bleeding, excessive narrowing of the upper throat, voice changes and occasionally death.
From researching your query, I learned that oral devices which pull the lower jaw forward (mandibular advancement) work better than surgery, and are preferred by patients over CPAP. Controlled trials show that mandibular advancement works in 50 to 70 percent of patients. CPAP reduces apnea spells better, so it's still my first choice, but mandibular positioning devices are now my second choice. However, they need to fitted by a dentist working with a sleep physician, as the jaw needs to be moved forward gradually over weeks to months to avoid pain in the jaw joint.
Sleep apnea can also be controlled by sewing a pocket with a tennis ball in the back of a night shirt so he won't sleep on his back. Losing weight, treating nasal stuffiness and avoiding alcohol, sleeping pills and tranquilizers within four hours of bedtime likewise can help reduce sleep apnea.
On Oct. 30, the Journal of the American Medical Association discussed a patient with sleep apnea who didn't even have daytime drowsiness. The journal advised possible sleep studies if a patient snored and had even one of the following: awakening with snorting/gasping, stopping of breathing, overnight awakenings, daytime sleepiness or awakening to urinate. We doctors aren't very good at diagnosing sleep apnea, so bring symptoms to our attention — or go ahead and tattle on your bed partner! It may save a life.
Dr. Landis Lum is a family practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine.
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