Sleep Tips by Dr. Andreas Prasadja, RPSGT // Snoring
Do you snore?
If yes, perhaps you suffer from Sleep Apnea ...
Snoring is considered normal by everyone. It is a normal belief that if someone snores, it means he/she is in a deep sleep. Or people who snore are lazy, always tired, always sleepy, listless, not productive and easy to fall asleep anywhere. This is the image portrayed by people who snore, but do you know that all of these can be explained and changed? Also, do you know that there are dangers lurking behind this habit of snoring?
There is a sleep disorder called Obstructive Sleep Apnea (OSA), which is indicated by excessive sleepiness and snoring. In this disorder, the upper respiratory tract constricts during sleep. This constriction causes vibration at the soft parts of the airway, resulting in snoring sound.
This constriction causes ineffectiveness in the exchange of oxygen and carbon dioxide during sleep. Furthermore, the increasingly relaxed muscles of the tongue causes tongue to fall backwards and completely clog the airway, resulting in stopped breathing (apnea). At this moment, drastic increase of carbon dioxide will activate a sensor in the body that will arouse the patient to continue breathing. Imagine if this occurs repeatedly during sleep. However, in the morning the patient does not know what happened during the night before because he/she was only awakened for a short period. But those mini arousals have disturbed the patient’s sleeping process. Their sleep was interrupted or fragmented. Consequently, in the morning the patient does not feel fresh and needs more rest without knowing that he/she was aroused several times during the night before. The patient also frequently complains of headache in the morning. While he/she does not feel sleepy during busy day, but sleepiness can strikes any time during meetings or driving and you can’t resist it! Mental abilities such as memory and concentration are also declining. Next is the deteriorating emotional quality, so that the patient will become easily upset or offended.
Because of the severity of snoring and disturbed emotional state, there are couples who finally decide to get a divorce. Too many lives have been lost in traffic accidents caused by sleepiness and declining dodging-reflex. These two examples already illustrate just how big the impact of OSA in human life. I often encounter patients with OSA who never want to drive anymore because he/she had or nearly had an accident. One of them even came to tears when recalling how he almost hurt his entire family because sleepiness struck while he was driving.
But we also can not underestimate its effect on health. Scientists have determined that OSA is a causal factor in hypertension, various heart diseases, diabetes and stroke. Some studies found a significant decrease in blood pressure after treatment of sleep apnea was done. After overcoming snoring, diabetes patients also showed a more controlled blood sugar level.
To diagnose OSA, a snorer must undergo overnight sleep study, where he will be recorded and observed during a full night sleep. What will be recorded include brain wave, muscle tension, eye movement, snoring sound, sleep position, respiratory airflow,breathing movement, heart rate, blood oxygen levels, and leg movement. This examination is not invasive or painful. You will only have some computer-connected sensors attached to your body, then sleep. Sleep study is usually conducted in a sleep laboratory using a device called polysomnography (PSG). The degree of severity of OSA is not determined from how loud he snores, but from stopped breathing and its consequences on the performance of the body organs during sleep.
After the diagnosis of OSA is established, treatment can be started. In the past, OSA is treated by tracheotomy surgery, where an incision is made on the patient's neck in order to insert a tube which will serve as a new airway, replacing the upper airway that often constricts during sleep. But now there are few therapeutic options available. First is a surgery to widen the upper respiratory tract (UPPP) by removing the uvula and soft palate. There is also plastic surgery or mouth surgery to improve airway constriction caused by small lower jaw. Dentists who are trained in the field of sleep medicine also suggest the use of dental appliances to prop up the mouth in order to prevent the tongue from falling backwards or to dilate the airway.
For now, the main option is to blow pressurized air into the airway during sleep in order to keep it open. During sleep, he/she wears a nasal mask or oral-nasal mask which is connected to a device called CPAP (Continuous Positive Airway Pressure). Initially, some people need to adapt first in using it. Difficulties in adapting to CPAP can be overcome with comprehensive assistance and information from sleep medicine experts and especially with the family’s support. Persistence in using CPAP continuously is very important for the improvement of disease and quality of life.
The use of CPAP becomes the top choice for many people because it is easy, without surgery or drugs, and significant improvements can be felt immediately after the first usage. Experts on sleep medicine also recommend the use of CPAP as standard therapy. The drawback is CPAP users can not kiss their partner because of the mask, but kissing is usually done before bedtime, isn’t it?
Whatever the chosen treatment is, behaviour and lifestyle still needs to be improved. For OSA patients with obesity, the success of therapy can be helped by weight reduction. Habits of smoking, drinking alcohol and taking sleeping pills should be stopped. Whereas for patients with mild OSA and snorers who do not have periods of stopped breathing, it is recommended that you sleep in tilt position to prevent the tongue from falling backwards. One effective way to do this is by attaching a tennis ball to your back to prevent supine position during sleep.
There are still many other sleep disorders which will be discussed in separate categories, such as insomnia, narcolepsy, periodic limb movements and parasomnia. Although not occurring as often as sleep apnea, these sleep disorders still need to be observed as differential diagnosis. OSA becomes priority because of the great number of patients who are not aware of this condition and its consequences. Hopefully, this short article can be a good start in increasing awareness of sleep hygiene.
One of the things we can do to reduce the chances of snoring is to select beddings (mattresses) which can follow body curve and support it properly. You also need to pay attention to the selection of correct head support (pillow). The purpose of above actions is to ensure sleeping position that can make the airway more open, and not causing obstructed airway or airway constriction. If the pain persists, please contact your doctor.