Ignoring Snoring: A Dangerous Truce

By Kerrin Leon White, M.D.

Do you have a bed partner who snores? What do you do about it?

Most complain to the snorer--not that it does much good, except to cause hurt feelings and irritation in the partner. The snorer rarely perceives, let alone controls, this unpleasant noise, even when it is loud enough to keep the whole house awake.

Others try rolling the snorer from a back to a side position. This may help, especially in milder cases; but the snorer, failing to appreciate the advantage, may soon roll right back into the familiar position.

A few find more lasting motivation to keep the snorer out of a supine position. One tactic with some success has been to sew a fair-sized object, like a tennis ball, into the back of the pajamas. The principle is to make it uncomfortable enough to sleep on the back that the snorer will stay in a side position.

Often, change of position doesn't solve the problem. The partner may resort to earplugs but discover they don't provide enough soundproofing. The unfortunate outcome may have the two "partners" occupying separate bedrooms.

But it is dangerous to ignore this possible warning sign of a far more serious condition: Obstructive Sleep Apnea (OSA), the interruption of regular breathing during sleep.

Not all snorers have OSA, but most people with OSA do snore, often to a disturbing degree. By itself, the occurrence of snoring represents some obstruction to airflow. The important questions are these:

Does the extent of obstruction underlying most snoring go to the extent of interrupting breathing? Actually lowering blood oxygen to dangerous levels?

Or even diminishing breathing for ten seconds or more? Or just making it more difficult for the sleeper to breathe normally?

Even such mild disturbances of breathing may have severe adverse consequences to the sufferer's sleep. These respiratory "events" can result in "arousals," not usually awakenings but lightening of sleep, as the body attempts to regain control of breathing.

The importance of these events and arousals is two-fold. First, the obstructive event results in blood pressure swings that may predispose to more sustained hypertension, a common complication of sleep apnea. Second, and perhaps most important in causing symptoms, is the disruption of deep, restful, "slow-wave" sleep, and the substitution of lighter sleep stages.

It has been estimated that at least twenty minutes of continuous, deep sleep are necessary for its restorative effects.

A person with sleep apnea, diagnosable in its mildest form at a frequency of 5 respiratory event-related arousals per hour of sleep, may have difficulty putting that much deep sleep together at one time. Imagine how impossible this becomes when, as in the most severe cases, these interruptions occur 100 times an hour!

One result is that, however much time the person with sleep apnea spends asleep--often much more than normal--there is no sense of being well rested. Instead, the person wakes up groggy, often with a headache, and suffers persistent daytime sleepiness, often resulting in long yet unrestful naps.

This constant sleepiness impairs functioning in all situations--at work, at home, in social settings, and even driving. It leads to an increased risk of accidents. It impairs memory and concentration. It leads to depression, irritability and mood swings.

Add this to the more medical complications of sleep apnea: strokes and heart attacks, in particular.

This is why it is dangerous to learn to "live with" snoring. Often it is the bed partner who is most aware of this major clue to other symptoms.

Once the suspicion of sleep apnea has been raised, it is equally dangerous to ignore the warning--dangerous not only to the person afflicted but to those who must share the road with half-asleep drivers.

The suspicion of sleep apnea, often raised by snoring, and supported by the other symptoms described, should lead to consultation with a board-certified sleep medicine specialist. This specialist will, in all likelihood, order the painless all-night sleep study, now paid for by virtually all insurance plans, which decisively makes or rules out the diagnosis.

If a person has sleep apnea, there is very effective treatment, both medical and surgical. In the final analysis, this potential for benefit makes the pursuit of this annoying snoring not only important, but also potentially life saving.