Snoring and Sleep disorders - Common questions asked

Is snoring abnormal?
Inspite of snoring being common it is definitely abnormal. It indicates there is an airway obstruction due to fixed physical causes like deviated nasal septum or dynamic sleep related causes like the loss of upper airway muscle tone as it occurs in obstructive sleep apnea. Regardless of the cause, snoring generally indicates the individual is not getting continuous flow of oxygen at sleep.

Is there any specific issues of sleep apnea with regard to the indian context?
We have been conditioned from early age by millennium old literature, novels and plays and also through recent movies and stories that associate snoring with good and restful sleep. The classic protrayal would be one who eats well and sleeps with snoring. Public awareness about sleep related diseases is low in india. Undergraduate medical training do not give sufficient importance to the specialty of sleep medicine. Another important issue is that epidemiological studies show indian patients diagnosed with obstructive sleep apnea have relatively lower BMI compared to individuals in western countries.Hence there is a need to suspect OSA regardless of the body weight.

Can an individual can have more than one sleep disorder?
Yes, some individuals have two of more sleep disorders. Sleep apnea is a continuum of disease with snoring/upper airway resistance syndrome as a baseline and progressing to obstructive sleep apnea with heart failure. Obese OSA individuals may have a component of obesity hypoventilation syndrome too. Central sleep apnea can co-exist in case of stroke or heart failure.

Body weight and sleep apnea. What is the relationship?
Generally individuals with the sleep disordered breathing are obese. It has been scientifically proven that any weight gain worsens the sleep apnea and similarly weight reduction would result in the reduction of severity and symptoms associated with OSA. It is a standard recommendation for all patients diagnosed with OSA to reduce weight.  

Do normal individuals snore?
Rarely normal individuals do snore when they take alcohol or sedatives prior to sleep.

Can I take sedatives for sleep apnea?
It has been found that sedatives worsen sleep apnea and hence not recommended in an individual is diagnosed with sleep apnea.

What is the effect of alcohol on sleep apnea?
Alcohol can also worsen sleep apnea. Alcohol preferentially suppresses the activity of the upper airway dilator muscles hence this may lead to upper airway obstruction. Alcohol makes a normal person to snore and would cause OSA in a previously snoring individual

What are the physical features that predispose to obstructive sleep apnea?
Obesity with high BMI
Short Neck
Large tongue
Long soft palates
Narrow pharyngeal lumen
Large Neck circumference
Pharyngeal dilator muscle dysfunction
Deviated nasal septum
Tonsillar enlargement
Small or retracted mandible
Hypothyroidism

Is apnea more common in supine position while sleeping?
Yes, The occurance of sleep apnea is more common in the supine position (lying flat on the bed) than in the lateral position. Individuals with OSA are advised to sleep in the lateral position as far as possible.

Is sleep apnea more common in men?
Yes, sleep apnea is more common in men. It is generally two to three time higher in the males compared to the females. It is presumed that hormone may a play a role as it is found that post menoupausal women have rates of OSA as high as males. Another aspect is the physical features including fat distribution around the neck may contibute to the increased prevalence among males.

Do children get sleep apnea?
Yes, in children the risk factors for sleep apnea syndrome are tonsillar and adenoidal hypertrophy

Is sleep apnea inherited?
Studies have shown that genetic factors play a role in the pathogenesis of sleep apnea. Genetics are important in view of the physical characteristics like obesity, short thick neck are heritable.