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Snoring is no joke

Treatments range from simple to surgery

Treatments range from simple to surgery

March 10, 2003|by KEVIN CLAPP

kevinc@herald-mail.com

A slight breeze cools your brow as you leisurely recline upon a chair set along a sandy beach. Beautiful blue water to dip your toes into is less than a stone's throw away. A cold drink is in your hand, and off in the distance approaches the boy/girl of your dreams.

This, you think, has got to be a dre-

SCHZZZZZNNNGGGHHHTTTT!!!!

The bedroom is dark, the island paradise is, in fact, a figment of the imagination. Another workday begins in six hours and the only sounds louder than the sputtering heating unit are the scattered grunts and snarls of your mate's snoring.

Sprawled on their back, they sleep easy, but you are already envisioning a sluggish day at the desk, struggling to stay awake through meetings and presentations.

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And they just won't quit it. You gently nudge them; they sputter, then resume, like a long-out-of-use lawn mower.

You push with more oomph. No luck. Finally, you jab them in the gut. They grunt, then roll onto their side. The snoring subsides.

No wonder they call snoring the sore rib syndrome.

"You treat the patient," says Chambersburg pulmonologist Peter Jablin. "But the bed partner gets the benefit."

First, the good news. Snoring, caused by air flowing through a constricted air space in the back of the throat or nose, is little more than a social nuisance.

At night, the muscles and tissues of the throat relax, losing tone and creating a smaller area for air to pass from mouth or nose to the lungs. When passing air vibrates against the uvula - the flap of tissue that hangs from the back of the throat - sound is created.

Snoring.

A larger than normal tongue, enlarged tonsils or a deviated septum in the nose cause similar effects.

When you are overweight, you are more apt to snore. Smoking causes inflammation of tissues and muscles in the throat, leading to snoring. Alcohol use before bedtime relaxes muscles further, resulting in, you guessed it, a greater chance of snoring.

Not surprisingly, says pulmonologist Shaheen Iqbal with Pulmonary Consultants of Hagerstown, sleeping on the back leads to more snoring than laying on your side, since gravity narrows the airway further.

To combat the snore, Iqbal and other pulmonologists recommend sewing a pocket into the back of nightshirts that can fit a tennis or golf ball. Rolling on the back causes discomfort, leading to more side sleepers and, hopefully, fewer loud zzzzzzzs to keep bed partners awake.

"It can be harmful to the person they are sleeping with, and it can be harmful because of the person lying next to them hitting them," says Robert Bowen, a pulmonologist at City Hospital in Martinsburg, W.Va. "All joking aside, it does affect the sleep of the other person in the room."

Sometimes, though, snoring is indicative of a larger problem that, if untreated, can be fatal.

Sleep apnea is the stoppage of breathing during sleep. The brain recognizes the lack of oxygen and stirs the body awake, though patients are rarely aware of waking up for a few seconds.

Jablin says 95 percent of those with severe sleep apnea snore, but not everyone who snores suffers from apnea.

Patients with sleep apnea often are sleepy during the day, apt to doze behind the wheel of their car or have a lack of concentration at work.

No wonder. To be labeled apnea, breathing must stop for at least 10 seconds, more than five times each hour. In some cases, patients have apnea episodes 200 or 300 times a night, Iqbal says, some lasting more than a minute.

"All they know is they go to bed at 10 o'clock and wake up after six, seven hours and still feel beaten up, fatigued," Iqbal says. "If you stop breathing and wake up 200 or 300 times in a night, you will not feel fresh the next day."

Easily diagnosed at sleep labs where patients are monitored during sleep to measure airflow and other muscle and brain activity, apnea can be remedied by a cumbersome apparatus, the Continuous Positive Airway Pressure mask, that regulates flow of oxygen to ensure airways remain open.

Another option is surgery to remove excess tissue in the throat. Jablin says the success rate for surgery hovers around 50 percent, in part because there is a limit to what can be removed.

Most often, pulmonologists encounter surprise from patients who don't believe they've stopped breathing so many times in the night, even though their mates have recognized a problem, whether snoring, stopped breathing or the snore-like snort likely to be made when a patient wakes themselves up from an apnea episode.

Other symptoms of sleep apnea include waking up frequently at night, or morning headaches. Sufferers may become forgetful, anxious or depressed.

As a result, Bowen says, it is gratifying to treat people for sleep apnea. And the old saw is true, he says. There really is nothing like a good night's sleep, and the feeling of refreshment patients experience because of it.

"There are a lot of jokes about snoring. People make fun of snoring. But there's a lot more to it than that," Bowen says. "And to people who have this happen, it's not a joke at all."

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