A potentially serious and common condition… SNORING, FATIGUE & SLEEP APNEA    By Dr. David P. White Dr. White is an Associate Professor of Medicine at Harvard Medical School, past President of the American Sleep Disorders Association (ASDA) and, through his position at Boston's Brigham and Women's Hospital, the Medical Director of Sleep HealthCenters™ LLC.

Sleep apnea, which is characterized by the repetitive cessation, or reduction, of airflow during sleep, affects millions of men and women. It is caused by subtle abnormalities in the anatomy and muscle control of the pharyngeal airway. The recurrent obstruction causes loud snoring, brief awakenings, and a rise in blood pressure. Such apneas may occur hundreds of times every night.

Chronic sleep apnea is associated with hypertension, excessive daytime sleepiness and, possibly, increased mortality The good news is that sleep apnea can be treated.

SNORING AND APNEA When you inhale, air passes through your nose and throat, flowing past soft-tissue structures such as the soft palate, uvula, tonsils, and tongue (see illustration at right) on its way to your lungs. While you're awake, the muscles surrounding your upper airway (throat) contract when you breathe and thereby keep the airway open. Although these muscles relax to some extent when you fill asleep, a normal individual is still able to breathe easily. If the airway behind the tongue, uvula, and soft palate is anatomically small due to increased weight, large tonsils, small jaw, etc., the airway may become partially obstructed during sleep when the muscles relax. This causes vibration of the tissues around the airway and the development of snoring. If the airway is particularlysmall, it may become completely obstructed during sleep when muscles relax, thus yielding an apnea ("no breathing"). As there is no breathing during an apnea, oxygen in the blood falls and carbon dioxide rises. When this occurs, the individual must awaken briefly to activate the airway muscles and open the airway. This generally occurs with a loud gasp or snore as breathing resumes. This routine may be repeated many times throughout the night, thus causing sleep to be fragmented and light. Despite the fact that the patient may not recall waking up even once during the night, he/she feels exhausted all day long. In addition, the recurrent fall in oxygen and frequent awakening from sleep may lead to high blood pressure. Some studies suggest sleep apnea may also contribute to the development of heart attacks and strokes, although this has not been firmly established.

SEE YOUR DOCTOR
If snoring or fatigue is upsetting your life or the lives of those around you, a doctor's examination and a "sleep study" may be helpful.

To be sure, monitoring your sleep during an overnight sleep study is the only way to tell for certain whether or not you have sleep apnea. A sleep study records your breathing, heartbeat, oxygen level, brain waves, and other events during sleep. The study is painless, and usually can be completed in just one night.

The study may be conducted either in a sleep clinic or in your home, depending on your symptoms. And, most health insurers cover sleep studies.

SLEEP STUDY
During a sleep study conducted in a sleep center, you would spend a night in a private room. A specially trained sleep technician observes the recordings throughout the night to ensure there are no problems with the equipment and that you sleep well.

After your sleep study results are thoroughly analyzed and interpreted, your doctor will then review them with you. If you have apnea, your doctor can make recommendations regarding appropriate therapy. There are a number of ways that sleep apnea can be effectively treated, and your physician can go over them with you.