Is snoring a disease?

Snoring is so common that most people may have experienced it at least sometimes during sleep. But the underlying problems associated with snoring can sometimes be very risky to our health and maybe even cause death in severe cases. So, it is prudent to treat it seriously and turn to a health care provider for help if you experience typical symptoms.

Q: Why do people snore? Is it harmful to our health?

A: Snoring is the hoarse or harsh sound that occurs when air flows past relaxed tissues in your throat, causing them to vibrate as you breathe. This is an abnormality. When the airway is smooth and the tissues are tight, they won’t vibrate and make such sounds when you breathe. But if the airway is uneven due to diseases such as hypertrophy of the tonsils or adenoids, or when tissues get relaxed due to old age or excessive alcohol consumption, it’s common for snoring to occur. People sometimes find that snoring gets quieter when lying on their sides because it can lower the amplitude of the vibration. But snoring is not the key problem. What we really worry about is sleep apnea syndrome (SAS), where snoring is a very common symptom. If a person snores all the time when sleeping, it’s not as serious because they are still breathing. But if the snoring stops, it can indicate the person has stopped breathing. If this happens it causes oxygen deficit which can lead to serious health problems.

Q: How dangerous is SAS?

A: First of all, SAS causes restless sleep and affects sleep quality. Sleep is very important as it should account for one third of our everyday life. If you have a sleep disorder it will definitely negatively affect your health. We’ve found that about one third of primary hypertension cases are related to SAS, while half of the people with SAS suffer from hypertension. For children, SAS may affect their growth and development as growth hormone is generated during deep sleep. For adults, if you don’t sleep well, it may cause disorders of hormone secretion. For example, if your insulin secretion becomes abnormal, it may lead to hyperglycemia, high blood sugar, or obesity. In the most serious cases SAS may even cause death. We’ve all heard of cases of sudden death in office workers. Actually, many of such cases are related to SAS as the suspension of breathing can cause lack of oxygen leading to myocardial damage, which may result in heart pause. If the pause is too long, it can cause death. So if you find someone who stops snoring during sleep, please awaken him or her so that they can resume breathing. It may save their life. The subject of sleep management is becoming more and more popular now as people realize just how important it is to our overall health. We recommend that people with SAS symptoms promptly seek medical consultation.

Q: How can people know whether they have SAS?

A: In our hospital, we have devices to specifically monitor sleep quality and blood oxygen content to help make a proper diagnosis. For example, we have a device to monitor how many times your breath weakens or stops for more than 10 seconds during sleep. If it’s less than 5 times per hour, it’s OK. If it’s 5 to 15, you may have light obstructive sleep disorder. It’s moderate when the number is 15 to 30 and severe when it’s over 30.

We also measure your blood oxygen concentration. Normally, it’s over 90 percent. When it falls below 90 percent, it means you lack enough oxygen. The deficit is light when it’s 85 to 90 percent, moderate when it’s between 80 and 85 percent, and severe when it’s lower than 80 percent.

There is a critical line. When the blood oxygen saturation is above 80, you are relatively safe even if you snore during sleep. But when it’s below 80, you are facing risk of sudden death and that risk is very high when it’s below 70. There are other related factors such as obesity and neck circumference. We all know that overweight people are more likely to snore. That’s because they have thick soft-tissue mass in the neck which restricts the respiratory tract. We’ve found that men with a neck circumference above 40 cm and women above 36 cm are more likely to snore and experience SAS. Other factors such as high blood pressure, high blood fat, and diabetes can all increase the risk of SAS morbidity.

People can make an initial assessment at home by observing common symptoms such as snoring, buccal respiration, and frequent breathing suspension during sleep. The most direct way is to ask your family members to observe your snoring or breathing during sleep. When your breathing is interrupted for longer than 10 seconds at least 5 times per hour on average, you might have sleep apnea and should seek a medical consultation.

You can also check if you have the following symptoms: consistent wake-ups during sleep, fatigue, headache or high blood pressure after waking up, drowsiness during the day, memory loss, lags in response, and hyposexuality (lack of sexual desire).

Q: Can snoring and SAS be treated?

A: Yes, they can be treated. There are different causes for snoring and SAS, so we will treat them accordingly. Some are caused by peripheral obstruction such as hypertrophy of the tonsil, nasal stuffiness, deviation of nasal septum, or nasal polyp. Some are caused by central nervous problems while others are a combination of causes.

In our hospital we have a cross-functional team integrated with members from across departments to analyze the causes and complications of patients’ sleeping and breathing disorders to make a diagnosis and recommend treatment plans.

There are many measures to help restore normal breathing. For example, we may do surgeries to correct deflected nasal septa or remove nasal polyps or tonsils. For those who cannot receive or do not require surgery, we have respirators. Not all breathing machines are large in size. Some are portable. The machines can help blow air into the respiratory tract and make people with breathing difficulty feel comfortable.

We would caution people not to buy such machines buy themselves. Individuals need to receive professional sleep monitoring first so that doctors can make the judgement if such machines are actually needed. Doctors will also help each individual adjust the machine capacity to the most suitable level for them according to their obesity, oxygen deficit, and breathing apnea levels. Patients also need to keep the machines clean to avoid infection.

In the future, we will have machines that can collect information of patients’ sleep remotely. One of the most important things for people suffering from SAS is to lose weight. Therefore in our team we include doctors from our endocrinology department. SAS can also have other complications besides snoring and may be treated by other specialist doctors.

Q: Do you have any advice to prevent or reduce the risk of SAS?

A: The first and most important advice is to maintain a healthy diet and stay in shape. The second is to moderate and control alcohol consumption. We should stop drinking alcohol at least three hours before sleep otherwise the alcohol will restrain the central nervous system and cause suspension of breathing. Thirdly, lie on your side during sleep, keep the nasal cavity smooth, and keep the room at a moderate temperature and humidity. Fourthly, we recommend regular moderate aerobic exercises such as swimming and cycling. And finally, stay happy and lead a healthy lifestyle. Get up when the sun rises and rest after sunset.