Air going through a narrow opening can make beautiful music in a concert hall, but when it goes through a narrow opening at the back of the throat, it produces the opposite of music: snoring. And if that snoring is loud, intermittent and accompanied by gurgling or gasping, it’s likely that you have sleep apnea. People with this disorder stop breathing while they’re asleep, usually because of an airway obstruction, wake up, then fall back asleep, sometimes hundreds of times each night.
Here’s what you need to know about sleep apnea.
1. Weight gain is a major cause of sleep apnea.
While being overweight is not the only cause of sleep apnea, it’s one of the main reasons why people develop this disorder, says Dr. Harvey Moldofsky, a sleep specialist at the Centre for Sleep and Chronobiology in Toronto. (Tip: If your neck circumference is 16 inches or larger [17 for men], you’re in the sleep apnea range.)
When people gain weight, fat accumulates in the neck, narrowing the opening through which air passes. With age, “everything gets a bit more floppy,” says Moldofsky, to the point where the muscles of the throat and tongue relax too much when you fall asleep. “The opening can get so narrow that everything sort of collapses and you start to choke,” he says.
Sleep apnea tends to run in families, the result of an inherited body shape, says Moldofsky; for example, a recessed jaw, a small jaw and a large tongue are inherited anatomical factors that contribute to sleep apnea. As well, some medications, including some antidepressants, may raise risks for the disorder because they make people hungry and cause them to eat more and gain weight.
2. Falling asleep at the wheel could be a tip-off that you have sleep apnea.
Excessive daytime sleepiness is common among people with sleep apnea, so if people honk at you when you drive, or if you drift from your lane of traffic, you may want to talk to your doctor. Other signs of the disorder include having problems with memory or concentration, making more than the occasional mistake and feeling grumpy and tired all the time.
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3. Continuous positive airway pressure (CPAP) is the gold-standard treatment for sleep apnea.
Getting people with sleep apnea to lose excess weight often doesn’t work, partly because tired people tend to snack to try to relieve fatigue, and sleep deprivation itself can cause hormonal changes that may affect appetite, says Moldofsky.
Many people turn to CPAP, which involves placing a soft gel mask over the nose and continuously pumping air into the mask to keep the airway from collapsing. “Yes, the mask will make you look like Darth Vader,” says Moldofsky, but it allows people to breathe and stops them from waking up hundreds of times a night. “People say, ‘For the first time in years, I feel alert and can do all the things I haven’t been able to do. And my spouse loves it,’” says Moldofsky.
4. In some cases, another treatment is indicated.
Alternatives to CPAP include the following options:
• Mandibular advancement. This custom-fitted dental appliance is placed in the mouth to bring the jaw forward and widen the airway. The device can be helpful for people with mild sleep apnea and costs between $1,200 and $1,500.
• Uvulopalatopharynoplasty, the surgical removal of the uvula (the fleshy structure that hangs down at the back of the throat) and part of the palate. This surgery resolves sleep apnea in less than 50 per cent of cases. Drawbacks include postoperative pain and risk of infection. It’s worth considering for the small minority of patients who can’t tolerate CPAP or for whom a mandibular advancement isn’t feasible; for example, people with dentures.
Sleep apnea prevention
The following steps may help prevent sleep apnea episodes:
• Avoid alcohol, sedatives and antihistamines before bed. These relax the throat muscles and can exacerbate sleep apnea.
• Change sleeping position. If you get sleep apnea when on your back, try sewing a pocket in the middle of your pyjama top and put a tennis ball into it to keep you from rolling on your back.
• Quit smoking. Smoking irritates the throat lining, which causes swelling and narrows the opening.
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