Sleep apnea can be a life threatening problem.  Take the STOP-Bang Survey & Epworth Sleepiness Scale to find out if you have an increased risk for sleep apnea.  As well, here are some general guidelines…You need a sleep study if:

1. Your bed partner has seen you stop breathing (witnessed apneas). They may say you are making loud snorting noises. These often follow a period where you stop breathing.
2. You snore nightly and have high blood pressure, diabetes, heart disease, or have had a stroke.
3. You snore nightly and feel excessively tired during the day.
4. You snore so loud you are considering a snoring procedure.

* One study looked at 92 people who snored nightly and 70% had at least mild sleep apnea. Knowing this before a procedure helps determine the best procedure and helps keep you safe during and after the procedure.

Why is snoring so common in humans and almost unheard of in other animals?

Other than bulldogs (and other brachycephalic dogs) with their short heads and long palates, there is no other animal that has sleep apnea. This is a complication of humans developing speech. Our speech required a shared canal for breathing and swallowing. Te changes in the airway led to the tendency to obstruct our breathing. We are also one of the only animals to routinely sleep on our backs making the obstruction worse. The natural bed partner reflex is to give them snorer an elbow to make them sleep on their side. There are many people with sleep apnea that only occurs when on their back.

What is the most important or common cause of snoring and sleep apnea?

Wait!  Here it comes…..’lose weight, exercise, and stop smoking and all your problems will be solved’.

Well, in most people this is true for snoring and sleep apnea.

About ten times more men snore and have sleep apnea than women…Why?

Progesterone, a female hormone, is protective. It helps keep the airway open during sleep. After menopause this hormone decreases and more women start to snore and develop sleep apnea. Testosterone, the male hormone, increases neck muscle bulk and causes fat deposition in the neck. This narrows the airway and makes it more floppy.

Snoring and sleep apnea becomes more common with age.  With age, everything gets a little droopy.  Elastic fibers get less elastic and muscle tone decreases in the throat making the throat more floppy and collapsible. 

What are the Health Consequences of Sleep Apnea?

The two largest studies and most referenced studies on sleep apnea are the Wisconsin Sleep Cohort and the Sleep Heart Health Study. In the Wisconsin Sleep Cohort,  1522 people were screened for sleep apnea and then all patients were followed to see what health problems would arise. A total of 709 patients had sleep apnea. In 4 years these patients were 3 times more likely to develop high blood pressure. The study has now been going on for 18 years. The most recent article was published in the August 2008 issue of Sleep.  It showed that people with severe sleep apnea were more likely to die of any disease compared to those without sleep apnea.

The Sleep Heart Health Study performed a home sleep study on 6132 people over 40 years old and then followed them. It showed sleep apnea increases your chances of developing high blood pressure, heart irregularities (arrhythmias), heart attack, stroke, pulmonary hypertension, workplace accidents, and motor vehicle accidents.

There is some debate in the literature of the ‘cut-off’, or how bad is bad? There is little doubt that people with a severe sleep apnea (AHI over 30) have significant increased health risks which can be reversed with treatment.

Although some studies suggest that even mild sleep apnea (AHI 5 to 15) have increased risks, other studies show no increased risks. If someone has other health problems, or is excessively tired during the day, I would recommend treatment.

Moderate sleep apnea (AHI from 15 to 30) is also a bit of a grey zone. Most studies show an increased health risk, but does treating it by CPAP (the ‘gold standard’) reduce these risks? My feeling is there is enough evidence that if I was in that range I would want to be treated, even if I was otherwise healthy and not excessively tired. There are multiple studies to show that we, especially men, are poor judges of our sleepiness. We tend to underestimate how tired we really are and overestimate our abilities. This leads to the increased car accidents and workplace accidents.

Treatment options include; an exercise and weight loss program, medical treatment to improve a stuffy nose and reflux, surgical treatment, appliance therapy, or CPAP.