More Than Just a Snore

Last week, I started to move in the direction of summer parties and picnics, so I hope you won’t be too disappointed if I backtrack just a little. I apologize for the morbid segue, but I had several personal reminders this week of a particular condition that can lead to cardiovascular-related death, and it is one that most people will “sleep right through” if it’s not brought to the forefront. You KNOW I can’t explain the pun without a story…

My husband returned from a two-month work trip this week. It is always so nice to have him home after a long absence. Truthfully, it is always an adjustment too—I like to go to bed early, he goes to bed a little later. I’m a breakfast person and eat lighter throughout the day, and he tends to skip breakfast and focuses more on big lunches and dinners. Oh. And I had to move my home nebulizer (more about that in November when we discuss respiratory!) from his nightstand so he would have room for his CPAP machine. Some of you have heard of a CPAP, correct? As a nurse, I am very familiar with this, and more so because I have two sisters, my father, and several friends that also use a CPAP.  

CPAP stands for continuous positive airway pressure. My mom had this old vacuum that would constantly get things stuck in it (it had absolutely NOTHING to do with unsupervised 11, 12, and 13-year-old girls sucking up things larger than a quarter…HA!) I was always able to remove the hose and screw it into the front of the vacuum, turn it on, and the item lodged in the hose would SHOOT across the room.  THAT, my friends, is positive airway pressure. Keep that in the back of your mind for now.

Most people that end up with a CPAP start with a significant other that smacked them many times or sent them out to the couch in the middle of the night for snoring. Folks, if you have a partner that snores, please pay attention. This means your partner’s airway is being at least partially blocked during sleep.  This could be obstructive sleep apnea (OSA), a partial or complete airway obstruction during sleep, and it can be related to multiple factors.

The greatest risk factors happen to be obesity and neck circumference greater than 17 inches. I have seen OSA resolve on its own with adherence to diet and exercise programs that result in weight loss. But know that one does not need to be overweight to suffer from OSA. Anatomical abnormalities can also affect airway patency, so don’t discount asking your doctor about OSA just because you exercise and eat right.

If you do, in fact, snore at night, you are probably experiencing frequent arousals during your sleep, and you are completely unaware of it. Are you commonly sleepy during the day? Having frequent headaches? Havin a hard time staying awake on the road? Irritable? Having difficulty concentrating? Do yourself a huge favor and talk to your primary care doctor. And if not for you, for your heart…

A major risk of OSA is cardiovascular complications. When your airway is obstructed, your organs are not getting the oxygen they need. When you have periods of apnea, or cessation of airflow, this increases the pressure in your chest. Try this. Take a deep breath and hold it for 10 seconds. Focus on the pressure you feel in your chest and abdomen. Imagine doing that…let’s say…every 45 seconds. All. Night. Long. And you don’t even know it!  Over time, this change in pressure increases your blood pressure and creates arrhythmias, or irregular heart rhythms, and interrupt blood flow to your heart. This combination can lead to heart failure!

(My audience is brilliant, and I KNOW you are all breathing again!?!?)

There IS hope for all you snorters, snorers, and midnight gaggers! Your primary care doctor should be able to recommend a sleep specialist. Set that appointment! Having a sleep study done is so much easier than it used to be. Back in vintage times, one had to report to the sleep study site and sleep THERE—in an unfamiliar bed, with all kinds of wires attached, where he was watched through a two-way mirror through the night (um, creepy.) Modern technology now allows test kits and instructions to be sent with you where you can be tested in the comfort of your own home. You return the kit the following morning for your specialist to analyze and make a recommendation.

The CPAP has been very effective for many people, also improving as technology has advanced. My husband no longer looks like he is going night scuba diving. He now wears a small tube strapped around his head and up against his nostrils, and like my weaponized vacuum, positive (and humidified) airway pressure is released, keeping his airway open (and moisturized) as he breathes in and out. More mild cases of OSA respond to simple things like positional therapy (changing sleeping positions). Mouth guards/oral appliances are also used to move the jaw and tongue forward to enlarge the airway space. Severe cases, or cases where other methods fail, can be managed surgically, with the goal of reducing the ease at which the parts of the upper airway can collapse.

So, ladies and gents—as my title says, it’s more than just a snore. We are talkin’ oxygen deprivation and heart failure here!  Set up that sleep study! Get oxygenated! And then take your rightful place on your side of the bed, and get that good night’s sleep so you can…

Be well!

 

 

 

 

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