Causes of Snoring and Sleep Apnea

Well if you think about it, you have a big tongue in a small mouth.  The majority of patients I have ever treated have a large tongue in a small mouth.  Here’s a simple visual: take your foot, whatever size, and try to put it in a shoe that is three sizes too small for you.  What happens?   It’s only going to go in so far.  Where’s the rest of the foot going to go?  Well, simply, the rest of the foot is going to hang out of the back of the shoe.

The same thing happens if you have a big tongue in a small mouth.  Your teeth are in the front and on the sides.  The only place there is room for your tongue to go is the back of the throat.   Now, something that almost everyone I have come across in my work, is that people find that they snore the worst when they sleep on their back.  I always here the comment, “my wife [or husband] elbows me to roll over.”  When a snoring person rolls over and gets off their back, the snoring is always less.  Why is this?

Let’s look at this at its most basic and logical level.  There is no super-secret or any sort of rocket science involved here.  Many articles you may have read regarding Sleep Apnea, or when you speak with many doctors about Sleep Apnea, they say that Sleep Apnea is about the airway collapsing.  It is not necessarily the airway collapsing as much as it is about the airway becoming blocked.

When a snoring person rolls over (after being elbowed by their spouse), their tongue moves and no longer blocks the throat.  But, if it was only about the airway collapsing, you could be on your left side or your right side or your front or your back when you are sleeping, and it wouldn’t make a difference.   You would still have the same closure of the airway.  Snoring and sleep Apnea would still occur.  But we know that’s not the case.   When you roll on your side your tongue no longer blocks the air passage and you no longer snore.

For the thousands of sleep studies that I have reviewed, almost every sleep study shows that the Sleep Apnea is worse when the patient is sleeping on their back.

If you look anatomically at what is going on, the only thing that would make the Sleep Apnea worse when you are on your back is the tongue falling back due to gravity.  And that is a very very big issue.  When we look at it logically, we find that the tongue falls back due to gravity and closes the airway.   Now, a partial obstruction of the airway is what we call snoring.  Snoring makes the noise it does because as the airway becomes blocked, or the diameter of the airway shrinks from the tongue falling back closing the airway.

Famed Engineer – Daniel Bernoulli’s came up with the principle that in general terms says that if the airway shrinks, the smaller the diameter, the faster the velocity or air speed that is propelled through.  This creates turbulence and the turbulence creates noise.  In this case it’s snoring.

Sleep Apnea is the complete obstruction of the airway where the airway remains blocked for a minimum of ten seconds.  It can be as much as 70, 80 or 90 seconds or more.  But when it stays blocked even once for at least 10 seconds, it is called a Sleep Apneac event.  A partial blockage is snoring and a complete blockage is Sleep Apnea.

Join me next week for my next article It’s All About The Tongue for an in depth look at the causes of the tongue blocking the airway.

Written by Dr. Jonathan Greenburg.

Dr. J. G is the head of the Snore no more centers in southern California.  Dr. G is the inventor of one of the only appliances that is a single lower mouth piece similar to a night-guard or orthodontic retainer that specifically addresses holding the tongue back from blocking the throat with no surgery, no noise, and very effectively.  Dr. G conducts post sleep studies with all of his patients.  The results are extremely high and comparable to those of the success of a CPAP – only without the cumbersome mask, hoses, and noise.   Sleep well!

In the August 1 issue of the journal Sleep, one of the studies was specific to a group of 1,522 adults that were tested for sleep apnea in an overnight sleep study. They were then followed up over a period of 18 years.

The results were astounding.

19 percent of the adults with severe sleep apnea died over the course of the study. Compare that with only 4 percent of people who died that had no sleep apnea. Approximately 42 percent of the deaths of those with the severe sleep apnea were directly related to heart disease or stroke.

“People with untreated, severe sleep apnea had four times the risk of all-cause mortality, and five times the risk of cardiovascular death,” said lead author Terry Young, PhD.  Ms. Young is a professor at the University of Wisconsin-Madison.

My goal here at Apnea-Treatment.com is to alert my readers, and perhaps those who think that they may have just a loud annoying snoring problem that it could be something that can cost you your life. These new studies are conclusive.

Young points out in her research that the repeated pauses in breathing causes a “compound stress.”  Blood pressure rises drastically. Irregular heart rhythms occur. Oxygen levels drop. Restorative sleep (REM) sleep is disturbed and apnea patients never get the rest they need. These pauses in breathing can happen 30 times per hour (or more) all night long. This stress takes a severe toll on the body.

Young also estimates that “10 percent of the adult population has a significant problem with sleep apnea.” She also fears that the rising rate of obesity adds more patients at risk for sleep apnea since obesity is a key risk factor.

As pointed out in previous posts, when a person has sleep apnea and is obese, they wake up tired, have no energy and can barely stay awake all day. These patients have a hard time modifying their behavior to lose weight because they are too tired to exercise. It becomes a circuitous loop of frustration. The studies that show how not getting restorative sleep affects the metabolism and putting people into a “pre-diabetic” state is also documented.

Another study done by Nathaniel Marshall, PhD, at the Woolcock Institute of Medical Research in Sydney Australia found similar results.  His research with 380 adults over a 14 year period brings him to this conclusion: “Or findings along with those from the Wisconsin Cohort, remove any reasonable doubt that sleep apnea is a fatal disease.”

The adults in Marshall’s study were tested with a portable home-monitoring device for one night.  33 percent of the study subjects with moderate to severe sleep apnea died during the follow-up period.  Only 7.7 percent of those studied that did not have sleep apnea died. Those with sleep apnea had six times the risk for death.

Both researchers point out that treatment is imperative and that the risk of death does not go down with time.  Though they discuss the effectiveness of CPAP as a potential treatment option, they do not mention anything about the cause of sleep apnea and other effective treatments for those who may not be able to tolerate a CPAP machine.

As a Doctor that treats Sleep Apnea and Snoring disorders in my clinics throughout the Los Angeles and Orange County areas, I see patients every day that know that this treatment is saving their lives.  At the risk of sounding overly dramatic it is important to see that these research studies confirm the fact that if you have sleep apnea, and leave it untreated,  your risk of dying is 19-33 percent higher than those who don’t.  Please don’t put off making an appointment with someone that can help you. You can call me directly at 888-31-SNORE.

Dear Amy: My wife insists that we sleep in separate rooms. She says I snore — and maybe I do, a little — but sleeping alone makes me feel emotionally alone.

I’ve tried to compromise, asking her if we could stay together for a while first before splitting — but she will not yield, not even a little.

I was sad, but now I’m angry too.

After 20 years of marriage, I feel utterly rejected.

Help!

Sleeping Alone

Dear Alone: I read an article recently saying that “snoring rooms” are the latest thing in home design.  These little soundproof bedrooms give everybody a chance to get a decent night’s sleep if there is a snorer in the house. But the idea isn’t that the snoring room will become a separate bedroom– but more of an occasional refuge.

I agree with you that your wife’s actions are destructive, and your reaction is completely understandable. The charitable assumption is that your wife is so disabled by two decades of interrupted slumber that it has made her lash out.

But I don’t think this is really about the snoring.

Snoring is a relatively easy issue to grapple with, compared with what you two are facing — a lack of intimacy and exile to emotional Siberia.

Whenever a relationship changes so radically, it’s safe to assume there is something major going on.

You need to get to the bottom of this, and a marriage counselor could help.

The response that Amy gives “Sleeping Alone” assumes that the core problem is a lack of intimacy and that going to a marriage counselor would be the best solution. Though a lack of intimacy may have developed over the years of snoring, it is not intimacy that is the problem…

As a Doctor that treats snoring and sleep apnea disorders, to say that “Amy” missed the mark in an understatement.

I am sure that Amy is simply unaware, that there is a sleep disorder epidemic going on.

The general public that she serves in her column is, like Amy, simply unaware that snoring has been linked to a silent killer that has been creeping into peoples bedrooms and destroying marriages just like “Sleeping Alone.”  For over 18 million people that have this disorder, snoring can be the very sign that exposes this insidious disease and alerts someone to the possibility that they may have a very serious and life threatening disorder called “Obstructive Sleep Apnea.”

What Amy obviously doesn’t know is that her advice to see a marriage counselor won’t do much good if hubby dies in the meantime from a stroke or a heart attack, both of which have been associated with untreated obstructive sleep apnea, which main symptom is snoring.

What “Sleeping Alone” needs is a trip to a qualified doctor, not a counselor.

He needs to be evaluated,  prescribed a sleep study to determine if the snoring is caused by obstructive sleep apnea, and get it treated.  Building a “sleep room” in new houses is a feeble  attempt to deal with a problem that doesn’t need rejection, or to be ostracized and banished to emotional exile.

It’s obvious that this syndicated columnist cares about her readers.

The advice she gives is on the mark most of the time, however a person like “Sleeping Alone” who snores should be evaluated and treated. Amy, and her readers, should be made aware that those who are suffering from snoring and sleep apnea can, not only get treatment, but extend their quality of life and have the chance to develop the very intimacy that they deserve and should be between them.

Perhaps Amy would be willing to add to her answer that she gave Sleeping Alone… it could save his life…

Image by mlhradio via Flickr

Are you personally experiencing, or know someone, who’s living costs are outstripping their monthly income as housing costs are skyrocketing, health-care costs, food costs and just about everything just costs more? It’s truly getting expensive to live.

Everyone knows that businesses have a “cost of doing business,” with the expenses they incur as they run the day to day operations of their business such as taxes, wages, overhead, disability insurance, worker comp, advertising, and on and on… there is a cost to run a business.

The fact is that there is a cost associated with just about any activity, and yes, even a cost associated with inactivity.

Sometimes doing nothing will cost more than doing something.. think of your car maintenance.What happens if you don’t change your oil, or let don’t change your brake pads? Your engine can seize up, or you find yourself replacing not just pads, but rotors, calipers and everything else… or worse, getting into an accident over something that didn’t cost that much to replace compared to the pile up that just happened. Yes, letting things go can have a huge cost associated with it doesn’t it?

So… what does all of this have to do with sleep apnea you may ask?

A few weeks ago I conducted a survey where I asked my subscribers what issues where important to them, and what were their concerns.

Of those surveyed 46.7% had concerns about having sleep apnea and 66.7% had questions about alternative treatments other than CPAP like an oral appliance. There were over 45% of people that were not treated but concerned! What opened my eyes was the next statistic.

85.7% of those surveyed were worried about the cost (expense) of getting treatment!

Yes, there is a cost of treatment, but there is an even greater cost of non treatment. The question I have for you is this: Which is greater? The cost of treatment or the cost of non treatment? This question gives new meaning to the term “Cost of Living.”

Here are some facts about the cost of living with untreated sleep apnea. Let’s put these in terms of value

Personal Cost:

Cost to Your Family:

Cost to Society:

If you are someone you love has sleep apnea and are worried about the cost of treatment, ask yourself this important question:

Are the costs of not getting treated more than I’d ever want to pay?

Call now for a free consultation.

Dr. Jonathan Greenburg
888-31-SNORE

Sleep apnea is a serious sleep disorder in which an individual actually stops breathing during sleep. While the person is in a relaxed sleep state, the muscles in the back of their neck and throat relax, allowing tissue from the soft palate to block the airway. This blockage triggers the brain to send constant signals to the body, causing frequent waking.

The sleep apnea cycle can be repeated hundreds if not thousands of times per night.The basic connection between the two ailments boils down to obesity. Both conditions are common in patients who are extremely overweight. In addition, these patients are more likely to suffer from insulin resistance.

Research has shown that the upper airway obstruction caused by sleep apnea can lead to a condition known as oxygen desaturation. This desaturation increases certain hormone levels such as cortisol, which causes increased insulin resistance. Increased cortisol levels are also common in diabetic patients. When levels are elevated, the body does not function properly and can create serious metabolic issues.

Cortisol is responsible for, proper glucose metabolism, regulation of blood pressure, insulin release for blood sugar maintenance and a variety of other biological functions. Another cortisol connection is the fact that it is often released when the body is under stress. A time of stress for the apnea sufferer is likely when the brain senses it is not receiving enough oxygen. To reduce the serious complications that sleep apnea and diabetes present, it is important to be aware of the symptoms of the conditions.

While not every sleep apnea sufferer is diagnosed with Type II Diabetes, having the condition puts you at greater risk of developing this and other serious aliments. In the end frequent monitoring and communicating health changes to your doctor are crucial to receiving the correct treatments and best possible patient care.

Traditional treatments with CPAP, though effective, has a high rate (over 60%) of patients that are intolerant to wearing the masks for a variety of reasons. As Dr. Ulysses Magalang, a sleep expert with Ohio State University Medical Center points out in the video segment, new alternative treatments are needed. New treatments like oral appliance such as the FDA approved Full Breath Solution, have over an 85% success rate.

Please do not hesitate to leave a comment or contact me directly at 888-31-SNORE

We’ve known the purpose of our other biological drives for hundreds of years: we eat to give our bodies energy, we drink to keep hydrated, we procreate to perpetuate the species – among other things. But what is the biological purpose of sleep?

It turns out no one really knows for sure. As correspondent Lesley Stahl reports, why we sleep is one of the biggest unanswered questions in all of science, which is why researchers all over the country are doing studies and coming up with some new and intriguing discoveries.
“We don’t sleep just to rest our tired bodies?” Stahl asks Matthew Walker, the director of the Sleep and Neuroimaging Lab at the University of California, Berkeley.

“Well, that’s been one of the long-standing theories. But I think what we’re starting to understand is that sleep serves a whole constellation of functions, plural,” Walker explains.

One thing that’s clear, says Walker, is that sleep is critical. In a series of studies done back in the 1980s, rats were kept awake indefinitely. After just five days, they started dying.”

The 60 Minutes piece also points out that research showed that patients that were sleep deprived and did not enter into REM (deep restorative sleep) were “pre diabetic” after only 5 days and found themselves ravenously hungry because there is a lack of a chemical in the brain that tells the body that it doesn’t need any more food. It shows us that lack of sleep can be a crucial part of the diabetes and obesity problems we are facing.

There are several other fascinating points made related to drowsy driving and several well known accidents. A National Institute of Health study done at the University of Pennsylvania by David Dinges, the scientist in charge, shared that “Studies show that all of that stuff people tend to do – slapping themselves in the face, rolling the window down, radio up, singing – they’re convinced it helps. But it’s only a matter of seconds or minutes. And you can have a sudden sleep attack right in the midst of doing that,” Dinges says.

And it’s not just driving. Dinges has examined, sometimes as an expert witness, the role of inadequate sleep in some of the world’s most well-known accidents.

He thinks inadequate sleep may have contributed to the Exxon Valdez oil spill, Chernobyl, the Three Mile Island disaster and the 2003 Staten Island ferry crash.

60 Minutes checked. The Exxon Valdez spill happened after midnight with a man at the helm who’d slept only four hours the night before; Chernobyl and Three Mile Island also occurred late at night and involved human error. And the assistant captain who crashed the Staten Island ferry into a pier, killing 11, admitted that he felt exhausted before the accident.

As a doctor who treats sleep apnea and snoring, I see this many patients who are pre-diabetic, exhausted and at risk of heart attacks and strokes. Many of these symptoms and risk factors are reduced if treated.

Let’s face it. We all need our sleep. (and if you snore…so does your spouse…) Get treatment. Don’t put it off.

The enitre article is located at 60 Minutes-The Science of Sleep.

Think you’re getting enough sleep? Take the Great American Sleep Challenge and find out!

Are you tired of feeling tired? Do you want to make a commitment to getting the sleep you need but don’t know where to begin? Then it’s time to take the NSF Great American Sleep Challenge™!

The Sleep Challenge is designed to make it easy for you to determine whether you’re satisfied with your sleep, and if not, to make changes and put yourself on a path to getting the sleep you need. Remember – sleep affects all areas of life including your health, productivity, mood and safety!

The Sleep Challenge takes place from March 3 - March 31, 2008. To take the Sleep Challenge, simply check out one of the many activities below. Don’t forget that you can enter for a chance to win a prize when you take the Challenge!

As a doctor that treats Sleep Apnea and sees the toll that a lack of sleep plays on so many individuals, I thought it would be fun to pass this information on to you.

“At midnight Sunday night, the National Sleep Foundation (NSF) will launch the 11th annual National Sleep Awareness Week® (NSAW). This award-winning, public education and advocacy campaign will focus intense media and policy maker attention on the importance of good sleep as well as the signs and symptoms of chronic sleep disorders that affect millions of Americans.

NSF’s education and policy initiatives have quickly gained momentum and despite many challenges, we are making significant and measurable progress in increasing recognition in Congress and the media that sleep and sleep disorders MUST be part of public health and disease prevention programs.”

For my part in helping to bring awareness and help educate the public I am doing a live simulcast that will be available either via the web or live phone call. I’d like to invite any of my readers to this live event that will be held as follows:

EVENT:  Dr. Jonathan Greenburg – Sleep Apnea
DATE & TIME: Wednesday, March 5th at 7:30pm Pacific
FORMAT: Simulcast! (Attend via Phone or Webcast — it’s your choice)
TO ATTEND THIS EVENT, CLICK THIS LINK NOW…
Live Sleep Apnea Simulcast-Dr. Jonathan Greenburg
I look foward to seeing you on the call!

As a Doctor that treats sleep disorders like apnea and snoring, I am saddened to hear of another death like this young man that could have potentially been treated and he’d still be alive.

When football legend Reggie White passed away with complications related to sleep apnea, it was shocking that it could happen to someone so young. Once again a young life is lost to a health condition that is easily treated. My hope is that Pimp C’s untimely death can help others and bring attention to bringing this medical condition under control.I am not his doctor, nor would I want to second guess his treatment, however many people who get diagnosed are prescribed a piece of equipment called a CPAP (continuous positive airway pressure) machine. This machine is somewhat bulky, noisy, has a mask that makes you look like Darth Vader and doesn’t help your love life. Many patients simply don’t use it because of those reasons.

On top of that, once it is prescribed, many times there is no real follow up with patients and they just “fall through the cracks” of ongoing successful treatment. These patients become what we refer to as CPAP intolerant. I don’t know how Mr. Butler was being treated and whether CPAP was prescribed. But the point is this: if he was actively using CPAP or an oral device like I recommend during his sleep he may still be alive.

Normally, when people with sleep apnea stop breathing they have a reflex that wakes them up. This is why many patients are so tired in the morning. They snore, stop breathing, wake up, and fall back to sleep. This never allows them to enter into restorative REM sleep. Perhaps the medications just kept Pimp C from waking up.The critical point being missed in all of the discussion of Mr. Butlers medical condition is the underlying fact that the cause of sleep apnea needs to be addressed and treated.

Obstructive sleep apnea is about an actual obstruction that stops you from breathing. The biggest obstruction is your tongue in the majority of the cases. If treatment does not address the tongue, then you are not really getting treated.

There are 18 million people with sleep apnea and many more who are undiagnosed. I would hope that anyone that snores, or is CPAP intolerent would at least take the time to get help. It could save your life.