QUESTION: I need urgent help. For the past three months I have been constantly exhausted. Most mornings I wake up with great difficulty. I also feel really groggy.
My partner is constantly on my case about me waking her up with my snoring.
She says I stop breathing when I sleep. I feel she is paranoid, but am concerned about my deteriorating function. I feel like a zombie for most of the day now.
ANSWER: The situation sounds very unpleasant. I’m sure it is placing major stress on your relationship. Disturbed sleep is a terrible thing and I do understand your partner’s frustration.
Snoring is often overlooked as a contributor to poor sleep and related health problems. People underestimate the long-term effects, besides losing a relationship partner or the passion in your bedroom.
Another misconception is that only obese people snore. Obesity is often a causative factor, but not always the only culprit.
It sounds that you have possible symptoms of obstructive sleep apnoea (OSA). Snoring in people with OSA is caused by the air trying to squeeze through the narrowed or blocked airway.
However, everyone who snores does not have sleep apnoea. Other factors may increase your risk:
* Retrognathia: a lower jaw that is short compared to the upper jaw.
* Palate shape that causes the airway to be narrower or collapse more easily.
* Large tonsils and adenoids.
* Large neck or collar size.
* Large tongue, which may fall back and block the airway.
* Sleeping on the back also increases sleep apnoea episodes.
OSA occurs when the flow of air pauses or decreases during breathing while you are asleep because the airway has become narrowed, blocked or floppy. A pause in breathing is called an apnoea episode. Hypopnoea is a decrease in airflow during breathing. Almost everyone has brief apnoea episodes while they sleep.
The symptoms of OSA are variable but we all need to know the warning signs. Feeling drained in the morning and feeling sleepy or drowsy most of the day is called excessive daytime sleepiness.
Complications include worsening depression, as well as hyperactive behaviour, especially in children. Untreated obstructive sleep apnoea may lead to or worsen heart disease, including heart arrhythmias, heart failure, hypertension and stroke.
How is the diagnosis made?
All good diagnosis starts with a detailed history, mostly centred on sleeping habits, and a timeline of events. This should be followed by a physical examination, including an assessment of the ENT system with particular attention to the airway.
By far the most useful test is a sleep study, a polysomnogram. A sleep study measures your sleep cycles and stages by recording various parameters – like blood oxygen levels, breathing rate and heart rate, as well as airflow. It is also useful in identifying central sleep apnoea which originates in the brain.
Dealing with the problem:
Avoid alcohol and sedatives at bedtime and try not to sleep on your back. Losing weight may decrease the number of apnoea spells during the night. Continuous positive airway pressure is now the first treatment for obstructive sleep apnoea in most people.
Some patients may need dental devices inserted into the mouth at night to keep the jaw forward. Surgery may be an option in some cases. Uvulopalato-pharyngoplasty is done to remove excess tissue at the back of the throat. This surgery has not been proven to completely clear up sleep apnoea.
* Dr Darren Green, a trusted figure in the field of media medicine, is a University of Stellenbosch graduate who adds innovative spark to health and wellness issues. He features on 567CapeTalk.
If you’ve got medical problems, contact the doctor at [email protected], 021 930 0655 or Twitter @drdarrengreen.
The advice in this column does not replace a consultation and clinical evaluation with a doctor.
Cape Argus