Snoring is a widespread phenomenon all over the world. The significant others of a lot of my patients complain about snoring. It is a major contributing factor in marital disputes.
Do we know what snoring is and what causes it? Snoring is a grunting sound produced during sleep. People who snore are often made fun of and humiliated. I have never seen a patient who came to my clinic with snoring as a presenting complaint. Similar to mental health disorders, there is an utter lack of awareness about snoring.
You often hear lame stories about snoring and its causes on television, which add insult to the injury. Snoring is a common symptom of a sleep disorder known as Obstructive Sleep Apnea. Patients snore, followed by hypopneic (30% reduction in airflow for 10 seconds) and apneic episodes (100% reduction in airflow) for at least 10 seconds. Common signs and symptoms are morning headaches, daytime sleepiness, fatigue, impaired concentration, irritability, and anger. If left untreated it can have grave consequences in the form of right-sided heart disease, hypertension, motor vehicle accidents, and even dementia (due to cessation of oxygen to the brain during apneic episodes).
Risk factors in developing OSA include obesity, short neck, male gender, smoking, old age and positive family history. OSA is often misdiagnosed. According to different studies, almost 80-90% of OSA patients remain undiagnosed.
Let’s talk about the management of OSA. We can screen patients by various questions, for instance Epworth sleepiness scale, Berline questionnaire, STOP-BANG questionnaire, etc. With the combination of clinical assessment and questioner results we can send patients for a sleep study in a sleep lab. Home sleep testing is available in which a sleep technician will come to your house and teach you how to set up the machine.
Treatment includes lifestyle style modifications, weight loss, smoking cessation, raising head end of bed and sleeping in a prone position. Weight loss is very beneficial in reducing the symptoms and severity of OSA.
Continuous Positive Airway Pressure (CPAP) machine the gold standard treatment. Patients wear a mask attached to a CPAP machine during sleep. It provides continuous flow of oxygen, preventing apneic/hypopenic episodes. In old times masks were hideous and bothersome. Nowadays the masks are sleek and comfortable. There are under the nose masks or nasal cushion over the nose masks and the whole face masks.
A lot of people use nasal strips to control snoring. They have no role in treatment of OSA. They might reduce your snoring a little bit but have no role in the treatment of the disease itself.
There is minimal public awareness of OSA. OSA is a lot more common than we think. We need massive public awareness about it. Not only do we need to educate the public but also physicians.
In the end I would like to say one thing: Primary care physicians should be more vigilant about screening for OSA. Some people never see a psychiatrist or neurologist in their entire life, so we should not leave it to them to diagnose OSA.
Dr. Ahmad Khan is a psychiatry resident physician at the University of North Dakota School of Medicine and Sanford Medical Center. He has made several presentations on sleep-related disorders, including a recent lecture at the North North Dakota Psychiatric Society fall meeting.