Dear Doctor Column, July 6, 2009

Question:

My husband snores, and sometimes he even stops breathing at night. Is there a treatment for this so we can both get some sleep? Should he ask his doctor about it?

Answer:

If he snores, his breathing starts and stops during the night, and he often is tired or sleepy during the day, your husband may have sleep apnea. Sleep apnea, which affects 15 million US adults, is most common among middle-aged men, but anyone can have it. Women have an increased risk of having it after menopause. It often goes undiagnosed because unless you describe your symptoms, your doctor will not know you have it. Sleep apnea puts you at risk for several serious medical conditions, so yes, your husband should mention it to his doctor.

Sleep apnea is characterized by pauses in breathing during sleep that can last from a few seconds to a minute or longer. There might be more than 30 pauses in 1 hour. After a choking sound or snort during which you awaken briefly, normal breathing starts again. People experiencing sleep apnea are not aware of being awakened, but when hundreds of these brief arousals occur every night you never experience full, restorative sleep, and you wake up feeling tired despite having “slept” 7 or 8 hours.

Apnea may also cause shallow breathing. Sometimes this happens because your airway has collapsed or is blocked. This is called obstructive sleep apnea (OSA). In the daytime your throat muscles keep your airway open, but at night those muscles relax, which may block the airway. Air squeezing through the narrowed passage causes snoring.

Other apnea causes include large tongue and tonsils, obesity, a large neck (bigger than 17.5 inches circumference), a narrow throat, and aging. Smoking also can cause swelling that leads to apnea.

Another type of sleep apnea is central sleep apnea, which is less common and happens when your brain does not communicate well with your breathing muscles. Central sleep apnea is usually caused by heart disease and, more rarely, stroke. It does not usually cause snoring, but the two types of apnea may occur together.

People with sleep apnea sometimes don’t know they have it. They may experience morning headache, lack of concentration and poor memory, irritable or depressed feelings, dry mouth, and insomnia. Children with sleep apnea may end up in odd sleeping positions, wet the bed, or breathe through their mouth.

Sleep apnea is a serious medical condition, and it’s important to tell your doctor if you think you or your spouse have it. Daytime sleepiness may cause a car or work-related accident. Having sleep apnea can reduce your quality of life if it causes depression or moodiness, sleep-deprived spouses, and difficulty performing at work. Apnea sufferers have an increased risk of high blood pressure, heart attack, congestive heart failure, stroke, diabetes, and death. Drops in blood oxygen levels while you sleep increase blood pressure and strain the cardiovascular system, doubling or tripling your risk of high blood pressure, and if you have heart disease and apnea, you’re at a higher risk for a cardiac event.

Your doctor will ask about your signs and symptoms and may suggest you have a sleep study. This is an overnight evaluation at a sleep disorder center that allows doctors to measure your breathing and other functions during sleep.

There are no medications for sleep apnea. Lifestyle changes, such as avoiding alcohol and medications that make you sleepy, losing weight, sleeping on your side, stopping smoking, and using nose sprays to open nasal passages, help many people. Some people with mild sleep apnea find that wearing a mouthpiece at night reduces mild sleep apnea.  A dentist or orthodontist can customize the mouthpiece, which adjusts the lower jaw and tongue to help keep the airway open.

Continuous positive airway pressure (CPAP) is the best treatment for moderate-to-severe obstructive sleep apnea. CPAP is a machine with a long flexible hose attached to headgear that most commonly fits over your nose. This allows the CPAP machine to gently blow air into the upper airway. The air pressure keeps the airway open so you can breathe. Some people don’t like the CPAP machine, which takes some getting used to, but for many people it provides the first good night’s sleep they’ve had in a long time.

Surgery helps some patients with obstructive sleep apnea. The type of surgery depends on the cause of the sleep apnea, but it may involve widening breathing passages, stiffening excess tissue in the mouth or throat, or tissue removal.

Your husband needs to tell his doctor about possibly having sleep apnea so that he can be evaluated. It is best if you would also go to his appointment so that you can relay what you observe when your husband sleeps since he cannot. For some insurance carriers, it also is important for apnea to be witnessed by someone other than the patient.