Dr. Fred Lin, director of the sleep surgery program at Mount Sinai, says snoring can be a red flag.
As the director of the sleep surgery program at Mount Sinai, Dr. Fred Lin treats patients who have complicated cases of sleep apnea that require surgery. Lin works with more than 500 patients a year with sleep apnea.
Who’s at risk:
About 50% of Americans snore while they’re sleeping. And for millions of people, that snoring is a symptom of sleep apnea.
“Sleep apnea is a form of sleep-disordered breathing in which the airway becomes narrowed as the tissues and muscles surrounding it relax,” says Dr. Fred Lin, director of the sleep surgery program at Mount Sinai. “The brain corrects for this suffocation by jerking the patient between deep sleep and light sleep, and even momentary awakening, though the individual doesn’t necessarily remember it.” Some 18-20 million Americans are living with sleep apnea, though doctors estimate that 80-90% of them remain undiagnosed.
Untreated sleep apnea majorly impacts quality of life — and also carries major health risks. “Because sleep apnea causes significant stress to the heart, it increases your risk of high blood pressure, stroke, heart failure and irregular heartbeats,” Lin says. “Besides the fact that patients are sleep deprived and often feel terrible, it’s crucial to treat this disease to protect your heart health. Thankfully, we have a range of highly effective treatments.”
What is the underlying cause of sleep apnea? “There are a lot of different theories, but the general principle is that the airway gets narrowed due to tissue/muscle obstruction. Your body usually has a sense when the airway is being narrowed, but after a while the nerve endings can get less sensitive,” Lin says. “Especially as people get older, many people gain weight and lose muscle tone. Women are at higher risk post-menopause due to hormonal changes.”
Doctors have identified a set of risk factors associated with sleep apnea. “Major risk factors include being male, being obese, having a history of hypertension and diabetes, and having a family history of sleep apnea,” Lin says. “People who snore are also more likely to have sleep apnea.”
Signs and symptoms:
One of the major red flags to be on the alert for is snoring.
“Snoring is considered a partial obstruction or blockage of the airway, and many times it is only the bed partner who realizes that the individual snores,” Lin says. “Other warning signs are daytime tiredness, not feeling like you’ve gotten enough sleep when you get up, headaches, irritation, mood changes and things related to sleep deprivation, like falling asleep at the wheel or falling asleep in meetings.” If you experience any of these symptoms, ask your doctor if you might be a candidate for a sleep study to measure the quality of your sleep.
The good news is that sleep apnea is a highly treatable disease. “We have both medical and surgical options that can bring sleep apnea under control,” Lin says. “The gold standard of therapy is the CPAP (Continuous Positive Airway Pressure), a device that uses air pressure to stent the airway open. But we also have options for patients who don’t respond well to CPAP.”
Patients wear the CPAP device at night while sleeping. “The patient wears a mask that covers the mouth and nose, while a tube delivers pressurized air,” says Lin. “There are several different variations available and the patient needs to wear it at least five nights a week, five hours a night for it to be effective.”
For patients who don’t respond well to CPAP, there are options that range from surgery to wearing an appliance similar to an oral mouthguard. “The surgical options generally entail doing a sleep endoscopy that allows us to use a camera to visualize the back of the mouth and base of the tongue where the obstruction is happening,” Lin says. “Then the surgery can remove or reshape tissue to prevent obstruction.” There are also robotic surgery options.
Sleep apnea drags down your overall health and your quality of life, but you do not have live with it. “This is something that is treatable in a lot of ways, so if one doesn’t work, we can try something else,” Lin says. “We can help you feel better and decrease the cardiovascular problems associated with sleep apnea.”
The treatment options available to sleep apnea patients continue to grow. “One of the newer options works as a stimulator for the tongue, which is the cause of the airway blockage for a subset of patients,” Lin says. “Surgically, there are always things coming down the pipeline. We’re still looking for a magic bullet.”
Questions for your doctor:
There’s no harm in asking, “Am I at risk of sleep apnea?” If your partner complains about your snoring, then ask, “Am I a candidate for a sleep study?” If you are diagnosed with sleep apnea, the question becomes, “How severe is my sleep apnea?” and “What treatment options do I have?”
“Sleep apnea and snoring can affect your day-to-day quality of life and your bed partner’s quality of life,” Lin says. “Having sleep apnea treated is crucial, both medically and in terms of your quality of life.”
What you can do:
Sleep in the right position. “If you’re snoring or having sleep issues, sleeping on your side is usually better than your back,” advises Lin.
Don’t ignore symptoms. And that includes feedback from your partner. “You can’t hear yourself snoring or when you stop breathing, but your partner can,” Lin says. If you sleep alone, be alert for symptoms and don’t hesitate to ask your doctor if you are a candidate for a sleep study.
Take preventive steps. Maintaining a healthy weight and avoiding alcohol and other sedatives at night cuts your risk of sleep apnea.
By the numbers:
— Sleep apnea affects 18-20 million Americans.
— 24% of all men and 9-10% of women have sleep apnea.
— 80-90% of sleep apnea cases remain undiagnosed.
Source: Dr. Fred Lin
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