ASK THE DOCTOR: Sleep Apnea and snoring
By JIM MITTERANDO
The Patriot Ledger

Q My husband is a horrendous snorer and occasionally stops breathing when he sleeps. I have read about sleep apnea and how this can be dangerous. I wanted him to have a sleep study but he will not go for one. Is surgery helpful? Should I push him to get treated?

A Snoring is the result of floppy, soft tissue in the back of the throat that vibrates when breathing during sleep. Snoring is not a medical problem, but it can strain relationships because the noise keeps others awake. Sleep apnea, ‘‘stops'' in breathing for 10 to 30 seconds at a time, may be a medical problem.

These short stops in breathing can happen hundreds of times during the night, causing poor quality sleep, frequent awakenings and daytime drowsiness.

Most apnea is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses and closes during sleep.

People often worry that their snoring partner will stop breathing and die. Rest assured, sleep apnea does not cause sudden death. The body will sense a lack of oxygen and wake.
Many treatments for sleep apnea also are helpful for treating snoring:

• Lose weight. A large neck (size 17 for men, size 16 for women) is a risk factor.
• Avoid alcohol and sedatives, which make the airway floppier.
• Avoid sleeping on your back. This can cause the tongue and soft palate to rest against the back of the throat and block the airway.
• Sleep on your side or stomach. To keep you off your back, try putting a tennis ball into a wide cloth money belt worn around the chest so that the ball is in the middle of your back.
• Treating nasal congestion may help snoring but will not help apnea. Prescription nasal steroid sprays (Flonase, Nasonex, Nasacort, Rhinocort) used daily may help.
• Breathe Right nasal strips do not help snoring or apnea, nor do over-the-counter products such as mouth sprays, etc.

People with sleep apnea and excessive daytime sleepiness that impairs function or driving must be evaluated and treated. This involves a sleep study where a person's breathing and sleep pattern are monitored in a laboratory. It costs around $1,000 but is often covered by insurance.

Nasal CPAP (continuous positive airway pressure) is the most common treatment for sleep apnea. The patient wears a mask over the nose during sleep that forces air pressure through the nasal passages to prevent the throat from collapsing during sleep. Unfortunately, it is not very comfortable and at least 50 percent of people will stop using it. Others report that it has helped them to have the first restful night of sleep in years.

Nasal CPAP costs around $1,000 and often is covered by insurance if a sleep study confirms apnea.

Wearing a mouthpiece at bedtime that pushes the lower jaw and tongue forward can help some people with sleep apnea. These orthodontist devices are more effective than surgery but not as effective as CPAP. Unfortunately, they generally are not covered by insurance and cost several hundred dollars. Some people cannot tolerate the mouthpiece because it can cause jaw pain.

Surgery for sleep apnea is the least effective and most risky treatment. The tonsils, uvula and soft palate are cut or burned to open the airway more. The procedure requires several days of hospitalization. It has a 30 to 50 percent success rate. Surgery is more effective for children with large adenoids and tonsils. Side effects can last up to two weeks after surgery. They may include severe discomfort, bleeding, infection. Death is rare. There are no long-term studies to show lasting benef its.

For those desperate snorers (without apnea) who pursue surgery as a quick fix to preserve their marriage, be warned - snoring often returns months or years after surgery.

Many sleep apnea sufferers report daytime drowsiness, which can make driving dangerous. There also have been associations between sleep apnea and high blood pressure and heart problems. However, these studies are weak because most of these sufferers are also overweight and have other cardiac risk factors. There are no long-term studies to show that treatment of sleep problems reduces other heart problems or prolongs life.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2003 The Patriot Ledger
Transmitted Tuesday, February 11, 2003