How to know when snoring is a sign of sleep apnea

A conversation with Dr. Brendan Lucey of Washington University’s Sleep Medicine Center

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It’s hard to beat a good night’s sleep. But for some, feeling refreshed upon waking up is no guarantee. Obstructive sleep apnea, a condition that causes breathing to stop and start throughout the night, affects millions of Americans. It occurs when the muscles in a patient’s airway relax and obstruct the passage of air, causing the person to snore loudly and abruptly wake over the course of the night. The disorder also affects the quality of a person’s sleep and leads to fatigue during the day. Although snoring might sound innocent enough, sleep apnea carries a range of serious health risks. Dr. Brendan Lucey, associate professor of neurology and director of Washington University’s Sleep Medicine Center, explains why the condition is nothing to sleep on.

Loud snoring is often a symptom of sleep apnea, but everyone who snores doesn’t have the condition. What are other symptoms? Feeling tired even after a full night’s sleep, morning headaches, mood swings, irritability, insomnia, and waking up with a choking or gasping sensation are among other symptoms.

A sleep study can measure the number of times a person temporarily stops breathing during sleep. How do these studies work? In-clinic and at-home sleep tests are available, but in-clinic studies, conducted in a specialized sleep laboratory, are considered the gold standard. Patients should expect to be at a sleep center for 10 to 11 hours. In addition to completing questionnaires about sleep before and after the study, patients will have sensors applied to their body to measure brain activity, airflow and effort during breathing, heart rate, oxygen levels in the blood, and leg movements. These sensors need to be attached correctly and tested to make sure the signal is high quality. Once this is done, patients will have eight hours to sleep and then these sensors will be removed. Some sleep centers have showers so patients may leave the test directly for work if needed.

What factors have contributed to the rising prevalence of obstructive sleep apnea? There are many factors. The primary factor is most likely the obesity epidemic. Increased body mass may lead to sleep apnea through multiple mechanisms, including increased upper airway narrowing and collapsibility, decreased lung volume, and increased effort breathing. Another factor is increased awareness of sleep apnea by patients and healthcare providers, which is leading to increased recognition of symptoms and testing.

The most common treatment for sleep apnea is continuous positive airway pressure, or CPAP. How long does it take for this kind of therapy to make a noticeable difference for a patient? CPAP machines are very successful at treating sleep apnea. Once the best pressure settings are determined, patients are likely to see benefits on the first night if they can wear it for most of their sleep period. For many patients, it may take time to acclimate to CPAP therapy since they aren’t used to sleeping with a mask on their face. In those cases, it may take a few weeks for them to see the full benefit.

When a CPAP is prescribed, will a patient need to use it for life? In general, patients who are prescribed a CPAP should expect to use it indefinitely. However, weight loss may reduce the air pressure patients need to treat their sleep apnea or decrease the severity of sleep apnea so that other non-CPAP treatments may be effective. That includes positional therapy, such as sleeping on your side. Weight loss and exercise provide enormous health benefits for blood pressure and metabolic function even if sleep apnea is not resolved.

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