Snore No More

How often does your partner or spouse jab you in the side because of your snoring throughout the night? If the answer is “all the time,” you could be more than just an annoyance to the person sleeping next to you. Loud snoring is a sign of a debilitating disorder called sleep apnea.

Apnea, by definition, is a temporary absence or cessation of breathing. And that’s exactly what happens to people with this chronic condition—while they’re sleeping. There are three types of apnea—obstructive, central, and mixed. “The one that we most commonly see is obstructive sleep apnea,” says Dr. Sanjay Godara, medical director at St. Joseph Center for Sleep Medicine in Bangor.

The obstruction is caused when the upper part of a person’s airway collapses during sleep. “The area at the bottom of your face and before it enters your ribs is very susceptible because there are no bones to protect it,” Godara says. “So when you lie down, biomechanics are working against you.” A person with obstructive sleep apnea snores heavily after falling asleep, becoming louder as time goes on. The snoring is then interrupted by a long silent period when the person literally stops breathing. This is followed by a loud snort and gasp and the snoring returns.

Obesity is a primary risk factor for sleep apnea. People with thick necks have a greater chance of constricted airflow to their lungs during sleep. Other physical factors include small jawbones, or large tonsils or adenoids, which can block air and cause a person to stop breathing while asleep.

“When that happens the brain detects that and alerts you to take a breath,” Godara says. “They are very light arousals and the brain does not form any memory because they are so short in duration. Just enough to get your breathing to restart.”

Those pauses of breath can last from a few seconds to a few minutes. For some, they occur three or four times an hour. But in severe cases, people with sleep apnea can stop breathing up to 90 times an hour. Medical professionals say the only true way to diagnose sleep apnea is to participate in an overnight sleep study.

“In the past five or six years, we’ve definitely seen an increase in the number of patients coming in,” says Dr. David Weed, medical director for the Aroostook Medical Center Sleep Disorder Center. “Oftentimes, people will come in thinking they can’t sleep because of depression or anxiety, and then we’ll discover they have obstructive sleep apnea.”

The first step doctors take in diagnosing sleep apnea is an extensive questionnaire. “Ours is six pages long,” says Jen Aspelund, director of sleep services at the Sleep Center of Maine at Sebasticook Valley Hospital. The Pittsfield facility is affiliated with the sleep clinic at Eastern Maine Medical Center in Bangor. “Two-thirds of those who complete our questionnaire end up needing to participate in an overnight sleep study,” Aspelund says.

Most sleep labs are set up with two or more beds. Much like a motel room, each patient has their own private room. Before going to sleep, tiny sensors are placed on the head and body to record sleep habits. Patients at St. Joe’s sleep lab have about 15–20 different sensors that technicians monitor constantly during the night.

“I hadn’t had a full night’s sleep in forever,” says Stanley Crossman. The Winterport man recalls falling asleep at work, and even while driving. “It would only be for a few seconds, but it scared me real bad,” he says.

The 58-year-old’s primary care doctor suggested Crossman participate in an overnight sleep study at St. Joe’s. “They recorded shallow or stopped breathing 136 times an hour,” Crossman says. He was fitted with a continuous positive airway pressure (CPAP) mask, the most common form of treatment for sleep apnea, to wear while he sleeps. “[The mask] gives you pressure to keep the airway open, sort of like a splint for your airway,” Godara explains.

“I haven’t fallen asleep during the day since I started wearing the mask” Crossman says. He admits not being a fan of the actual device itself, calling the mask “a nuisance” to wear. “But, it makes me feel better,” he says. Crossman has been using the mask for about three years now, and says he hasn’t gone one night without it.

Other types of treatment for sleep apnea include medications, surgery, or a dental device to help keep the airway passage open. Most sleep labs will recommend that a patient come back for a second study, this time wearing the prescribed device, to make sure it truly is working.

A small number of people with obstructive sleep apnea can be cured with something called positional therapy, according to Patrick O’Leary, clinic educator for the Sleep Center at Eastern Maine Medical Center. “They’re fine on their side, but once they switch to their back, the snoring and apnea episodes start occurring,” he says. In order to keep these sleepers on their sides, doctors will suggest a number of positional therapy tools, including tennis balls in the back of t-shirts. “They don’t feel so wonderful when you switch to your back while sleeping,” O’Leary explains.

National statistics show that more than 18 million Americans suffer from sleep apnea. And, an estimated 10 million people don’t even realize they have it. Most cases occur in those 40 years old and older. However, doctors are seeing more children and teenagers than a decade ago, according to O’Leary. “We’ve prescribed the CPAP mask to kids that are 14, 15, and 16 years old,” he says. O’Leary adds that in most of those cases, there’s a direct correlation between obstructive sleep apnea and obesity.

Sleep apnea can worsen over time if it goes undiagnosed. And, it can have a domino effect on the overall health of a person. “If you have high blood pressure and difficulty sleeping, if you have depression and difficulty sleeping, if you have a history of heart disease and difficulty sleeping, those are all reasons to consult your doctor or a board-certified sleep medicine specialist about the possibility that you may have sleep apnea,” recommends Dr. Weed.

Crossman says he had never heard of sleep apnea before being diagnosed with it. “I wish I had. Getting the mask was the best thing that ever happened to me.” And, he adds with a smile, “My wife says I’m not as grouchy anymore.”