Loud snoring isn’t something to be dismissed as annoying; it’s a sign of something far more dangerous. It could be a symptom of sleep apnea, a group of sleep disorders where your breathing stops and starts throughout the night, repeatedly. These disruptions can leave you feeling exhausted and contribute to major health problems down the line.
Dubai-based Priyamvada Singh (name changed on request), a psychologist explains from her own experience: She would get annoyed with her husband’s snoring at night. However, she grew a little worried when she observed that he had several headaches during the day and was in a permanent state of mild fatigue. She recalls, “I put it down to stress at work, at first. However, one night, I heard this really worrying choking sound from him, brief as it was. It terrified me, and after that, I realised that he needed medical attention.” A sleep study revealed his diagnosis: Obstructive sleep apnea, a type of sleep apnea, where it was observed that he woke up around 15 times an hour, which was leading to a fractured sleep pattern. Moreover, what was more concerning, as he stopped breathing for more than five seconds at a time.
So, what really is sleep apnea?
An endless state of fatigue
Mohammed Harriss, Consultant Pulmonology, Medcare Royal Speciality Hospital, Al Qusais and Claudine Gillard, a Dubai-based sleep consultant, and Asher Shaikh, a homeopathy consultant from Wellth, elaborate on what exactly sleep apnea it is. The word 'apnea' is derived from Greek etymology and means 'without breath'. In sleep apnea, people experience recurrent episodes of apnea, which means cessation of breathing, and hypopnea, and shallow breathing, throughout sleep. These disruptions can lead to hypoxemia, a condition characterised by abnormally low blood oxygen levels. There are a multitude of reasons behind sleep apnea, which can range from obesity, where fat deposits around your neck can obstruct your breathing, to genetics where you might have inherited a narrow airway. Other possible reasons include medical conditions, such as heart failures, stroke, high blood pressure and Type 2 diabetes, that increase the risk of sleep apnea. In these cases, the brain fails to send the proper signals to the muscles that control breathing.
Sleep apnea is a a group of sleep disorders characterised by repeated interruptions in breathing during sleep. These interruptions, called apneas, can last for several seconds and occur multiple times per hour. It can lead to daytime fatigue, cardiovascular problems and overall decreased quality of life...
There are several telltale signs of sleep apnea, as Joanna King, a Dubai-based sleep specialist explains. “It starts with unfinished sleep, regardless of how much you rest. Even if you try to sleep more on weekends, you feel unrefreshed and fatigued. This disturbed sleep makes you feel as if you stayed up all night. Worse, this daytime sleeping can have dangerous repercussions, as people who suffer from it fall asleep in precarious situations, such as driving or while working for example —as they are constantly woken up in the middle of the night by their disrupted breathing," she says.
As Gillard adds that with 7-9 hours of sleep, untreated sleep apnea leaves you tired. The disrupted sleep due to frequent awakenings can also lead to weight gain, owing to the increase in cortisol and raises your risk of other health problems. Moreover, chronically poor sleep fuels stress, anxiety, and impacts daily functioning.
The different kinds of sleep apnea are:
Obstructive sleep apnea (OSA)
This is the most common type of sleep apnea. King explains, “Normally, air flows freely through your mouth and nose, delivering oxygen to your lungs without interruption. However, in OSA, this smooth flow is repeatedly blocked throughout the night. These complete pauses in breathing are called apneas or apneic episodes.”
Even with 7-9 hours of sleep, untreated sleep apnea leaves you fatigued. The disrupted sleep due to frequent awakenings can also lead to weight gain, owing to the increase in cortisol and raises your risk of other health problems. Moreover, chronically poor sleep fuels stress, anxiety, and impacts daily functioning...
It is a common understanding that OSA is more frequent in older, middle-aged men, especially those who are overweight and obese. King explains, “As men age, they tend to experience a decrease in muscle tone throughout the body, including the muscles in the throat and tongue. These weakened muscles can collapse more easily during sleep, narrowing the airway and leading to apneas. Another probable reason, is that they are more likely to gain weight around the middle, called visceral fat, as they age. This excess fat tissue around the neck can further constrict the airway, increasing the risk of sleep apnea,” adds King.
A risk for men and women
Nevertheless, you don’t have to be overweight to suffer from sleep apnea. A 2017 US-based study published in the American Library of Medicine, has found that at least one in four people afflicted by it have a body mass index that is within the normal range. Many studies such as a 2015 US-based study published in the academic journal, Journal of Thoracic Disease, have also estimated that OSA often goes undiagnosed in women due to several factors. One key reason is that women reported different symptoms, compared to men. The study noted that they suffered from insomnia, restless legs syndrome, depression, nightmares, heart palpitations, while men typically report snoring and nighttime breathing difficulties.
King adds, “The risk for women also increases significantly after menopause due to hormonal changes and fat distribution.” The reason behind this, she elaborates. Prior to menopause, the hormone progesterone helps prevent the upper airway from becoming obstructed. However, it declines after menopause. Other hormonal changes can influence the distribution of body fat. And since postmenopausal women tend to have a higher fat mass compared to the period prior to menopause, their apnea risk is elevated.
Central sleep apnea (CSA):
This happens when your brain fails to send proper signals to the muscles that control breathing, owing to several possible problems such brain injuries or strokes. As Shaikh explains, "The effects of the trauma are imprinted in the autonomic nervous system as part of the fight, flight, freeze response and may lie dormant for varying periods of time, until triggered by life stresses, resulting in the appearance of sleep apnea symptoms."
Mixed sleep apnea: This is a combination of both OSA and CSA.
Witness apnea
For some people with sleep apnea, the first clue comes not from themselves, but from their partners. Doctors refer to this as witnessed apnea.
King explains, "It's often the partner who refer the patient. It's not the snoring that can be disturbing; it's also the sudden silence that follows. It is quite frightening for the partner because they worry that the person isn’t breathing.”
King also points out the difference between normal snoring and the snoring that persists in sleep apnea. “While snoring is a common occurrence, not everyone who snores has sleep apnea. Occasional snoring is generally considered normal. However, sleep apnea is commonly associated with snoring. Several factors can differentiate between normal and pathological snoring: intensity, loudness, and frequency. Infrequent, quiet snoring is unlikely to be a health concern. Conversely, persistent loud snoring significantly increases the likelihood of sleep apnea,” adds King, explaining that snoring associated with sleep apnea is destructive snoring due to its disruptive and intense nature.
Why sleep apnea can be fatal
It can be fatal if left unaddressed, as Laila Qadri, a Dubai-based sleep specialist adds. As she says, “The repeated drops in oxygen levels and strained breathing efforts during sleep apnea put a significant amount of stress on the heart. This can lead to conditions like arrhythmias, which are irregular heartbeats, high blood pressure, and even heart failure. The lack of oxygen and increased strain on the cardiovascular system can also elevate the risk of stroke. During a stroke, blood flow to part of the brain is interrupted, which can cause brain damage and even death.” King also explains that there is a rather strong connection and a ‘two-way street’ between blood pressure and sleep apnea, too: High blood pressure can also worsen sleep apnea by making the upper airway more likely to collapse during sleep.
How sleep apnea is detrimental for you, and everyone around you: What research says
In addition to the potential for serious health consequences, sleep apnea can also deeply affect a person's mental well-being. In 2019, scientists at the US-based Centers for Disease Control and Prevention, a public health agency, have found that people with obstructive sleep apnea have a significantly higher risk of depression. The relationship between sleep apnea and depression is rather complex, as King and Harriss explain, it disrupts your natural sleep cycle by repeatedly causing you to stop breathing and wake up briefly, even if you're not fully conscious of it. This fragmented sleep leads to a decrease in deep sleep stages, which are crucial for feeling refreshed and mentally well. This daytime fatigue and difficulty in concentration leads to chronic stress, worsening the depression.
However, one of the most troubling consequences of sleep apnea is that it affects people around you, too. As a 2015 study titled Sleep Apnea Related Risk of Motor Vehicle Accidents is Reduced by Continuous Positive Airway Pressure, published in the UK-based academic journal Sleep, explained that it can make you two and a half times more likely to be involved in car accidents. A 2016 review published in the US-based National Library of Medicine showed that it nearly doubles the risk of workplace accidents. As the specialists summarise, recent years, several high-profile transportation accidents, including train, bus, and car crashes with multiple fatalities and injuries, have been linked to untreated sleep apnea.
How can you treat sleep apnea?
Living with obstructive sleep apnea (OSA) doesn't have to hold you back. There are a variety of effective treatments available, including medical interventions, devices, and lifestyle modifications, explain the specialists. Finding the right approach with the help of a doctor might take some exploration, but with personalised care, you can significantly improve your sleep quality and overall health. However, one rule that you need to adhere to, especially if you’re overweight: Work on shedding those pounds, as that’s one way around sleep apnea, suggests Hareb.
A 2009 study published in the US-based Archives of Internal Medicine found a significant connection between weight loss and improved sleep apnea. The research showed that obese participants who lost weight through diet and exercise experienced ‘clinically relevant’ improvements in their sleep apnea severity. Moreover, the best benefits were observed in individuals with the most severe apnea and the most significant weight loss. Conversely, participants who didn't lose weight during the study saw their sleep apnea worsen.
