Snoring and Sleep Apnea

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In 1910 the average amount of sleep was nine hours a night. Today, it’s just seven. Over 100 million Americans snore. The record snore came from Melvin Switzer who topped 92 decibels, according to Guinness. (Heavy traffic is 80dB!)

Seriously, though, sometimes snoring is associated with sleep apnea (AP-knee-ah). That means breathing stops, sometimes for minutes. As the body uses up remaining oxygen, the chemistry of the blood can change, and pretty soon the heart beats irregularly.

Next stop: heart attack.

New research at UCLA also notes that, when people strain to breathe and break the logjam in their throat, blood pressure goes way up. This, in turn, damages the inside of the lining of the vessels in the neck.

CPAP machines can be lifesaving if you have compromised breathing when you sleep...but...

Sick of wearing the cumbersome CPAP device every night?

Prevent closure of the breathing passages with a simple oral appliance.

The next thing we know these people have little sores on the inside of their arteries. This is where things stick and build up the clog that stops up blood flow inside the arteries.

This can lead to strokes. Interestingly, people who have sleep apnea have ten times the amount of clogged arteries in their necks.

We can often help with special appliances designed to keep the airway open.

Snoring--You May Need Evaluation

Here are just SOME of the things we look at when we do an evaluation for possible sleep apnea:

• reports of snoring or stopping breating while asleep
• reports or evidence of acid coming up into the throat or mouth (GRD)
• a neck size over 17"
• a recessive jaw
• deep overbite
• scalloping on the side of the tongue
• enlarged tonsils
• a high, arched palate (roof of the mouth)
• allergies
• high blood pressure
• high body mass index--over 30
         calculate your own BMI: http://www.nhlbisupport.com/bmi/
• a closed posterior of the mouth
• space under your chin less than about a half inch
                  
• ...and more...

But...you may very well need proper analysis by a physician for this potentially life-threatening condition.  This could involve a POLYSOMNOGRAM, a testing procedure that can really analyze what goes on when you're sleeping.

What is a polysomnogram?  Click here

Good news: we now have a service that will send a technician to your home to perform the sleep study, rather than having to go into the strange surroundings of a sleep center.

What's more, there are a number of new, portable home sleep recorders coming on the market.  You simply hook yourself up to a few sensors and go to sleep.  Meanwhile, the system records how often you stop breathing, how much oxygen your system is taking in, and whether you are snoring.

Thanks to colleague Kent Smith for his good counsel in this field.

Sleepiness and Car Accidents

People with sleep apnea have at least TWO TIMES the risk of car accidents:

http://sleepwellandlive.wordpress.com/2008/02/14/people-with-sleep-apnea-at-increased-risk-for-auto-accidents/

Take the Epworth Sleepiness Test: click here

What does it mean?

You MIGHT have sleep apnea.

NOTE: It's NOT just about preventing life-threatening apneas.  Your dentist can frequently help cut down on snoring and improve the over-all QUALITY of your body-restoring rest.  And that can go a long way to improving the quality of life.

Women Who Snore

Snoring is considered by many to be a man's problem, or at least more prominent and dangerous for men. Not so. An estimated 19% of women also snore, and are just as prone to developing snoring related complications as are men. Sleep apnea, closely allied to snoring, can strike people of either sex.

Women, however, have their own complications with which to cope. A news story dated April 27, 1999 reports that snoring is also associated with high blood pressure in pregnancy, and high blood pressure leads to a more serious problem known as pre-eclampsia.

There are indications that partial obstruction of upper airway passages may be the cause of the night time increase in blood pressure that causes the more serious pre-eclampsia. If not controlled, it may be necessary to hospitalize the patient to protect mother and child.

In a recent study, a group of women suffering from pre-eclampsia were put on CPAP(positive pressure ventilator), with the majority experiencing a marked reduction in blood pressure levels.

Several things contribute to snoring, such as smoking, weight, high cholesterol and sleeping on the back. Hormones and oral contraceptives also play a part in this dangerous mix.

Women who snore have a higher risk of hypertension and heart disease. The probable cause of these complications is a reduction in blood oxygen. Women who snore, therefore, should seek medical advice, and, if deemed necessary, take part in a sleep study. this is even more urgent during pregnancy.

 Dentists: contact us for a comprehensive continuing  education video program on sleep apnea.                

Review a sleep questionnaire:

1) What time do you typically go to bed? ______________   When do you typically wake up to start your day? ___________

2) Do you have difficulty falling asleep at the beginning of the night?                                                                                     Yes    No

      If yes, on average how long does it take to fall asleep?   _________

3) Do you have difficulty staying asleep throughout the night?                                                                                                  Yes    No

       If yes, how many times do you wake up during the night? _______

             How long does it take you to fall back to sleep?   ________

4)  Do you experience an unsettled, restless sensation in your legs while lying in bed?                                       Yes    No

         If yes, how frequently?   Occasionally,  About 50% of the time,  Almost every night. 

5) Have you been told that you make kicking and twitching movements while asleep?                                                        Yes    No

6) Do you snore at night?                                                                                                                                                     Yes    No

       If yes, how would you rate the severity?   Mild      Moderate    Severe

7) Have you been told that you have pauses in your breathing while asleep?                                                                          Yes    No

8) Does your bed partner frequently sleep in another room because of how you sleep?                                                     Yes    No

9) Circle those statements that apply to you:

     Do you frequently wake up with    -a dry mouth   -headaches   -excessive sweating  

        -Choking or gasping    -nasal congestion   -chest pain   -heart burn   - drooling on the pillow 

10) Are you sleepy during the day?                                                                                                                                     Yes    No

11) Do you take naps often, and if so for how long?             _______________________                                                  Yes    No

12) How many caffeinated beverages do you consume each day? ____________________

13)  Do you occasionally awaken feeling paralyzed?                                                                                                  Yes    No

14) Do you experience sudden loss of strength in your legs or arms during the day?                                         Yes    No

           If yes, are these brought on by a sudden frightening event or laughter?                                                     Yes    No

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How likely are you to doze off or fall asleep during the day  in the following situations, in contrast to feeling just tired?

0 = would never doze      1 = slight chance of dozing      2 = moderate chance of dozing     3 = high chance of dozing

             Situation                                                                                                                            Chance of dozing

Sitting and reading                                                                                                                                0                1                2                3

Watching TV                                                                                                                           0                1                2                3

Sitting, inactive in a public place (i.e. theater)                                                              0                1                2                3

As a passenger in a car for an hour without a break                                                  0                1                2                3               

Lying down to rest in the afternoon when circumstances permit                            0                1                2                3   

Sitting and talking to someone                                                                                         0                1                2                3

Sitting quietly after lunch without alcohol                                                                    0                1                2                3

In a car, while stopped for a few minutes in the traffic                                              0                1                2                3               

Please list your MEDICATIONS in the space below:                                                                                                                        

Please list your MEDICAL CONDTIONS PAST and PRESENT and any sleep problem not covered with the questions above.

Berlin Questionnaire (for sleep apnea)

Height (m) ________ Weight (kg)________ Age______ Male / Female

(used to computer body mass index)

Please choose the correct response to each question.
CATEGORY 1
1. Do you snore?

a. Yes

b. No

c. Don’t know
If you snore:
2. Your snoring is:

a. Slightly louder than breathing

b. As loud as talking

c. Louder than talking

d. Very loud – can be heard in adjacent
rooms
3. How often do you snore

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never
4. Has your snoring ever bothered other
people?

a. Yes

b. No

c. Don’t Know
5. Has anyone noticed that you quit
breathing during your sleep?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never

CATEGORY 2
6. How often do you feel tired or fatigued
after your sleep?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never
7. During your waking time, do you feel
tired, fatigued or not up to par?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never
8. Have you ever nodded off or fallen asleep
while driving a vehicle?

a. Yes

b. No
If yes:
9. How often does this occur?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never

CATEGORY 3
10. Do you have high blood pressure?

Yes

No

Don’t know

Scoring Berlin questionnaire

Categories and scoring:
Category 1: items 1, 2, 3, 4, 5.
Item 1: if ‘Yes’, assign 1 point
Item 2: if ‘c’ or ‘d’ is the response, assign 1 point
Item 3: if ‘a’ or ‘b’ is the response, assign 1 point
Item 4: if ‘a’ is the response, assign 1 point
Item 5: if ‘a’ or ‘b’ is the response, assign 2 points
Add points. Category 1 is positive if the total score is 2 or more points
Category 2: items 6, 7, 8 (item 9 should be noted separately).
Item 6: if ‘a’ or ‘b’ is the response, assign 1 point
Item 7: if ‘a’ or ‘b’ is the response, assign 1 point
Item 8: if ‘a’ is the response, assign 1 point
Add points. Category 2 is positive if the total score is 2 or more points
Category 3 is positive if the answer to item 10 is ‘Yes’ OR if the BMI of the
patient is greater than 30kg/m2.
(BMI must be calculated. BMI is defined as weight (kg) divided by height (m)
squared, i.e., kg/m2).
High Risk: if there are 2 or more Categories where the score is positive
Low Risk: if there is only 1 or no Categories where the score is positive
Additional question: item 9 should be noted separately.

Listen to Need for Sleep Radio:

http://www.need4sleepradio.com/staff.htm

Sleep problems are reported by:

• 82% of those diagnosed with depression
• 81% who have suffered a stroke
• 76% being treated for heart disease
• 75% diagnosed with lung disease
• 72% being treated for diabetes or arthritis
• 71% of those diagnosed with hypertension

We are lucky to have some physician resources in our area:

Click here- The Snoring and Apnea Center of California is a medical practice dedicated to the evaluation and treatment of snoring and sleep apnea. Visit www.snoring911.com (what a great name!)

   ---------------

New Millennium Diagnostics can actually send someone to your home, so you can get your testing done while sleeping in your own bed, in a much more private setting: 949-813-5805

   ---------------

Local polysomnogram sleep study: Sleep Disorders Center 1011 N Euclid Ave, Upland    call 866 753 3762  

See www.SleepDisordersCenterInc.com.

We are a proud member:

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Do you think I'm sexy?

  MSNBC.com

Apnea aid raises doubts Hoses, masks and whirring noises make CPAP romance a little challenging

By JoNel Aleccia
Health writer
MSNBC
updated 9:39 p.m. ET, Thurs., March. 20, 2008
Babbett Peterson thought there was nothing less sexy than her husband's snoring - until he brought home the cure.

The 47-year-old Trabuco Canyon, Calif., woman took one look at the plastic face mask, the long tubing and the whirring motor that ran all night and decided there were worse things than a few snuffles and snorts.

As far as she was concerned, the Continuous Positive Airway Pressure machine - known as a CPAP - was a threat to her 22-year marriage.

"Things were great in the bedroom," Peterson said. "Then there was this thing strapped to his head."

Peterson and her husband, Chris, a 47-year-old engineer, are among growing numbers of couples whose romantic lives have been derailed by sleep problems - or their solutions.

Bedtime troubles send three in 10 couples to separate rooms, according to a poll by the National Sleep Foundation, a nonprofit agency. About a quarter of people with partners and 10 percent of singles said sleep problems left them too tired for sex.

Snoring is the most obvious interference, sleep experts say, but some users contend that the most commonly prescribed cure - the CPAP machine - can put an even bigger damper on libido.

"It's a huge emotional loss," said Peterson, who works as an executive assistant. "I am a cuddler. I felt like I couldn't touch him."

Peterson's opinion isn't the most popular view in the online support group at www.sleepapnea.org, the Web site aimed at people who suffer from the serious sleep disorder that advocates say involves so much more than snoring.

People with obstructive sleep apnea have a problem that causes their airways to collapse during sleep, cutting off breathing sometimes dozens - or even hundreds - of time a night. Because they awake over and over, they're never fully rested and often wind up with the chronic, life-threatening consequences of extended sleep deprivation.

Compared to the possibility of high blood pressure, heart disease and stroke, looking less sexy at bedtime is a minor concern, said Barbara Ruggiero, who coordinates the southern Nevada chapter of the AWAKE support group run by the American Sleep Apnea Association.

"I couldn't have cared less," said Ruggiero, 49, a married mother of two from Las Vegas who started using a CPAP nearly three years ago. "It's not just the snoring; people do die from sleep apnea."

But while CPAP users are grateful for the treatment, dozens of posts on the popular apea Web sites reveal some also are worried about the social consequences of the cure.


"I am having a hard time seeing an educated, attractive man looking for an over-weight single mother (2 year old girl) who also has the joy of wearing a full face mask to bed," one 27-year-old woman wrote.

"It's a very big thing," acknowledges Edward Grandi, executive director of the sleep apnea association that counts 10,000 registered members in its ranks. "We hear that a big challenge is having somebody that's coming to bed with all these accoutrements as opposed to just their jammies."

Like sleeping with Darth Vader And the challenge is growing with the number of sleep apnea sufferers. An estimated 4 percent of men and 2 percent of women between the ages
of 30 and 60 in the United States suffer from severe sleep apnea, Grandi said.

That's at least 18 million Americans who shuffle through life in a sleep-deprived haze. Only about 10 percent of sufferers are diagnosed, but the most common prescription is a CPAP.

Still, less than half of those sent home with a CPAP wind up using it, experts said. It's easy to see why. The machine works by blowing a stream of air down a plastic tube and through a plastic mask, using the pressure to keep airways open.

Even the most streamlined models can't hide the Darth Vader-like effect of slipping on the device and flipping the switch, acknowledged Dr. William Orr, a sleep expert and president of the Lynn Health Science Institute at the Oklahoma University Health Sciences Center.

"It's like sleeping with a vacuum cleaner strapped to your nose," he said. "You wouldn't go around dating somebody and put this thing on and say, 'Hey, look what I've got.'"

While CPAP wearers complain about claustrophobia, inconvenience and the weird effect of being plugged into the wall all night, their partners have other issues.

The noise of the motor can be annoying, like leaving a blow-dryer on for hours, although some users insist the new models are no louder than a large fan or a refrigerator. The CPAP's steady stream of exhaled air also can bother partners who suddenly feel like they're sleeping in a wind tunnel.

After 46 years of marriage, Jim and Ann Hurd of Colorado Springs, Colo., had to stop cuddling because of her CPAP machine.

"My husband and I were snugglers all night long," said Ann Hurd, 66. "But he doesn't like the cold air blowing on him."

And there's no question it's hard to feel seductive while wearing the thing. Vern Hulse, 66, of Ririe, Idaho, has worn a CPAP for seven years, so when his wife, Betty, 63, got one last fall, she didn't mind.

"But if I wore one and he didn't, I might have been a little vain," said Betty Hulse. "If I were a young woman in my 20s and I was alone, I would wear it, but if I had an overnight visitor, there's no way."

Despite those obstacles, CPAP users and sleep experts said the benefits of the machine far outweigh the impositions on intimacy.

'Most unromantic device ever'

Sleep-deprived people are not good partners, noted Rosalind
Cartwright, chairman of the of the psychology department at Rush University and founder of the school's sleep disorders center. She calls the CPAP "the most unromantic device ever," but says using the machine or an oral applicance can rescue a troubled marriage.

"You don't want somebody to go untreated," she said. "When people are sleepy, they can keep up their work role, but their husband role, their parenting role, their love role, they can't keep it up."

That's often true in a sexual sense as well. In addition to
life-threatening health problems and psychological symptoms, people with untreated sleep apnea often suffer from impotence and other disorders.


Unexpected perks

For Reid Johnson, a 28-year-old salesman from Charleston, S.C., using  the CPAP caused some funny moments with college girlfriends, but also some unexpected benefits.

"The relief of being able to sleep and have energy again was so great that I did not care what anyone thought," Johnson said. "And, after the mask my libido unquestionably went up. I had energy again and was not always sick."

Now married, Johnson said his CPAP doesn't hamper his sex life. His wife, Christina, even nicknamed the device Snuffalufagus," he said.

Most CPAP users say they're as matter-of-fact about the device as anyone who needs crutches, prosthetics or other aid for a serious medical condition - and that they expect romantic partners to be the same.

"I've never been self-conscious about it," said Vicki Thon, a
50-year-old single mom who has balanced CPAP use and an active social life for 11 years. "I say, 'This is what I need to be healthy.'"

For couples who can't tolerate the device, there are a few options.  Chris Peterson, for instance, lost 20 pounds, decreased his snoring - and ditched the machine, much to his wife's delight.

"We got our life back," Babbett Peterson said.

When that's not possible, CPAP users have to cultivate a sense of humor - and a practical view, said Grandi, the apnea association director.

"No, it's not sexy, but I don't think snoring is sexy," he said. "And, you know, you don't have to do it with the mask on."

© 2008 MSNBC Interactive
URL: http://www.msnbc.msn.com/id/23731731/

The Snore Relief Wrist Band from Hammacher listens to your snoring to 'gently' shock you to stop.  They claim that 80% in their study experienced some reduction in snoring within two weeks and had 'better sleep quality'.   Well, we're skeptical...