Sleep Disorders. Part 2. Sleep Apnea -- When snoring is the symptom, not the disease

Last week we publiihed an essay on snoring, its causes, varying degrees of severity, and the types of remedies people have sought. I observed that there is very little literature in scientific and medical journals on snoring and that, untif recently, it was not treated as a medlcsf problem at all. 1 However, this picture is beginning to change due to the recent interest in a breathing disorder known as sleep apnea, which afflicts only very loud, “heroic,” or “obnoxious” snorers, and which, left untreated, can seriously undermine their health. Sleep apnea is only one of many sleep dkorders now recognized as posing potentially serious threats to people’s physical and mental well-being. Table 1 lists some of the sleep abnormalities which are currently being stud]ed and treated. The table was prepared from a special supplemental issue of the journal S/eep. That issue is devoted to the “diagnostic classification of sleep and arousal dlsorders.”z These disorders range from the inability to stay awake to the inability to sleep, and from organic problems such as neurologi!eal, cardiovascular, and motor dworders, to emotional or psychological problems which interfere with norrnaf sleep patterns. “Apnea” comes from the Greek term meaning “want of breath.”s People with sleep apnea have difficulty sustaining breathing during sleep and often stop breathing for intervals of up to two minutes throughout the night. Some sleep apnea sufferers have as many as 600 to 800 apneic episodes in a single night, taking only two or three normal breaths at a time between episodes.d Thus, as Mark Pressman, Sleep Disorders Center, Medical College of Pennsylvania, Phdadelphia, points out, they may spend as much as 75 percent of the time they are sleeping without getting oxygen. S Thii places a strain on the cardiovascular system and may lead to a number of complications, some of which can be fatal. But because the condition is only ob vious while a person is asleep, the maj ority of people with sleep apnea do not realiie they have a medical problem and do not seek help.d Sleep apnea sufferers are typicalfy overweight males over the age of 40. Men are thought to be between ten and 60 times more likely to develop the disorder than females. b Although sleep apnea in young women is virtualfy unknown, the dkease can occur in women, particularly if they are postmenopausal or obese. ? Children too can develop sleep apnea, usually due to a throat obstruction stemming from enlarged tonsils or adenoids. s There are two basic types of breathing defects which can cause sleep apnea. “Central sleep apnea” results from a failure in the breathing reflex which controls the respiratory muscles in the chest and diaphragm. ThB form of sleep apnea rarely becomes a problem in adults. It is seen more frequently in infants, and may be responsible for many cases of “crib death.”q “Obstructive sleep apnea” is far more prevalent among adults and is the type of sleep apnea associated with snoring.4,7 During episodes of obstructive sleep apnea, the throat closes and