Sleep disorders: snoring, sleep apnea
According to the insomnia, nocturnal respiratory disorders are a separate form of sleep disorder. Sleep apnea is far more consequential to health than normal snoring
Snoring: Not only robs the sleeper from sleep
The nocturnal snoring concert usually arouses only the bed neighbors. The snorer himself usually does not or rarely perceives it. As you sleep, the muscles in the pharynx become slack, and soft tissues begin to vibrate in the breeze of the breath. They also narrow the airways, especially in the supine position, when the tongue base falls back. This reinforces the noise problem.
Enlarged pharyngeal tonsils, jaw malpositions are among the anatomical causes. Also obesity promotes the loud breathing technique when fatty deposits around the tongue, throat and neck alter the spatial relationship of the upper airways. Further reasons for nocturnal sawing concerts are a nasal obstruction due to infections and chronic sinusitis. Alcohol causes the muscles to relax, coffee or smoking swell the mucous membranes at night. Breathing is correspondingly difficult and noisy. In old age, the muscles in pharynx weaker. That’s why older people snore more often. Affected are usually men over 50 years.
Symptoms : Often, snoring does not significantly affect the sleep quality of the snorer himself. Except his Mitschläfer awaken him again and again. It can also happen that he hears his sawing in sleep subliminal and thus awake briefly without being aware of it. The snorer then says that he has slept well but feels tired , chipped and underachieving during the day . Even a dry mouth in the morning can be a clue.
Diagnosis : Diagnosis includes the report of Mitschläfern. Here it is important for the doctor to distinguish annoying but harmless snoring from nocturnal pauses in breathing (see below). Medical history and physical examinations give further indications, especially on risk factors for sleep apnea.
Therapy : There are many tips and tricks against the unwanted disruptive sounds, such as how the snorer avoids coming to the supine position (see Sleep Apnea). If anatomical peculiarities such as too much pharyngeal tonsils or jaw problems are present, the doctor and patient may consider whether they do not have to be treated anyway. Here is an ear, nose and throat doctor or an orthodontist asked. Also, surgery on the soft palate may be indicated, but only if special anatomical conditions exist. Chronic sinusitis will be assessed by the ENT specialist and recommended for appropriate treatment.
Usually, however, it is general measures that a snorer can take to create more nocturnal rest: lose weight if you are overweight, if possible avoid alcohol, do not smoke, drink a little coffee. And: sleep enough. Because who is tired, snores more often. There are also special nasal patches or nose spreaders that sometimes facilitate breathing.
Sleep apnea: When breathing stops during sleep
Violent, irregular snoring may, however, be a sign of a serious nocturnal respiratory disorder, for sleep apnea (Greek apnoia = breathlessness). Physicians speak of sleep apnea syndrome, because here several disease factors interact. The pharyngeal and pharyngeal muscles slacken much stronger in sleep than in normal snoring.
In the most dangerous and common form of respiratory disorder, obstructive sleep apnea , they block the upper airways almost completely, so that the breathing air can not pass through for a short time. It comes to respiratory arrest. As a result, the oxygen content in the blood decreases, the carbon dioxide concentration increases. Increasingly, stress hormones are being released. All of this affects other organ functions such as the heart and circulation or the lungs. Finally, with the help of the respiratory muscles of the chest, abdomen and diaphragm, the affected person succeeds, sometimes under considerable effort, in opening the displaced airways from below by means of air pressure. The sleeper gasps, snoring loudly.
After a short recovery, the cycle starts again. The heart has to do more work, the blood pressure rises. Also increases the risk of diabetes mellitus. The quality of the individual sleep phases changes, the sleep becomes more superficial overall, the sleeper wakes up again and again through the respiratory distress, usually without even noticing it.
There is a close correlation between sleep apnea and cardiovascular diseases, respiratory diseases, strokes and depression . For example, heart patients often suffer from sleep apnea, while sleep apnea patients are more at risk of developing heart disease. In addition, risk factors are obesity – most commonly overweight men between the ages of 40 and 65 are affected by the disease – enlarged tonsils, tumors in the nose and throat area, narrow jaws. Alkolhol as well as sleeping pills and sedatives increase the problem.
Symptoms : Very loud snoring that changes with breathing pauses and heavy breaths. The respiratory arrest may occur five to ten times and more in one hour, and may last for ten seconds or more. The sleeper himself usually does not notice the nocturnal episodes, but often develops an excessive need for sleep (hypersomnia) and feels tired during the day, chipped off and only of limited capacity. The pronounced daytime sleepiness considerably increases the risk of accidents. Accompanying symptoms include high blood pressure, cardiac arrhythmia, headache , heartburn , depression, anxiety . Breath failure and snuffling without snoring are characteristic of the so-called central sleep apnea.
Diagnosis : Only in certain forms of sleep apnea, those affected by their respiratory distress wake up and thus consciously perceive. For most it is the daytime symptoms that cause the doctor to also suspect sleep apnea. Particularly important here are the information of the Mitschläfer.
If necessary, an ear, nose and throat doctor will check if the upper airways are narrowed. Occasionally, an examination may be indicated by a sleep-medical-trained dentist, orthodontist or oral-maxillofacial surgeon including X-ray of the facial skull. If there is a suspicion of a disease of respiratory organs such as the heart, lungs and nervous system, investigations in this direction are appropriate.
If there is an urgent suspicion of a sleep apnea syndrome, measurements with a polygraphic device for the home, which the patient can attach to at night (see also chapter “Physical illnesses “), can be effective. Otherwise an examination in the sleep laboratory will ensure the diagnosis (see chapter “Diagnosis” ).
Therapy : Each treatment initially includes basic measures that affect lifestyle and sleep habits. Often changes in these areas already help to improve a slight sleep apnea. First and foremost is to lose weight for people with obesity. Since alcohol and sleeping pills dampen the respiratory activity at night, the affected persons refrain from doing so better. This also applies to smoking .
In addition, it makes sense not to sleep on your back if possible. It often helps to sew a small ball, a raised foam part or similar in the back of the pajamas. The pressure automatically forces the sleeper back to its side position. Sometimes special bite splints help to increase the breathing space.
If such measures do not help alone in the case of more severe clinical pictures, ventilation therapy can counteract the respiratory disorder. In most cases, so-called positive positive pressure ventilation (CPAP stands for English Continuous Positive Airway Pressure) is used. The sleeper wears a small breathing mask attached to a compressor on the bedside table. At night, the air flows at slightly elevated pressure into the airways, which remain open in this way. According to studies, the symptoms such as daytime tiredness, depressive mood or high blood pressure improve rapidly and sustainably with CPAP breathing.
Essential: The person concerned breathes in this form of ventilation therapy itself. Most of the therapy is designed as a long-term treatment, especially in the forms of obstructive sleep apnea, which are not otherwise treatable. This means, for example, that those affected use their CPAP device continuously, for example while traveling. In addition, there are other forms of pressure ventilation.
If necessary, the doctor will specifically treat existing basic or secondary diseases of sleep apnea, such as cardiovascular problems or diabetes .
Surgical measures are only indicated and successful in the case of nocturnal respiratory disorders if there are special malpositions in the jaw-throat area.