PART 6

The Silent Killer: Unveiling
the Hidden Dangers of Snoring

The Alarming Link Between Snoring and Life-threatening Illnesses

In a world where medical advancements are common, it is surprising that snoring and sleep-related issues remain largely overlooked. However, recent studies have shed light on the undeniable connection between snoring, sleep apnea, and serious health conditions such as cardiovascular disease. This article aims to explore the profound implications of snoring, emphasizing the urgent need for recognition, diagnosis, and treatment.

One groundbreaking study funded by the National Heart, Lung, and Blood Institute (NHLBI) revealed a frightening association between obstructive sleep apnea and sudden cardiac arrest. Over five years, the researchers followed more than ten thousand Americans diagnosed with sleep apnea, and a staggering 142 individuals died of sudden cardiac arrest. The study identified three common predictors among those who died: age sixty or older, oxygen saturation below 78 percent during sleep (considered low), and more than twenty episodes of breathing pauses or shallow breathing per hour. These findings underscore the need for immediate attention to snoring and its potential risks.

The Unaware Snorer and the Burden on Loved Ones

One of the primary challenges with snoring exists because those affected often remain oblivious to their condition. It is often their bed partner, family member, or roommate who bears witness to disrupted sleep patterns, sometimes enduring years of suffering. Sleep deprivation not only affects the snorer’s loved ones but also places them at risk of chronic health issues and psychological distress. This distress can even lead to resentment towards the snorer, often resulting in couples sleeping in separate bedrooms. Unfortunately, societal stigma often prevents snorers from acknowledging and addressing their problem, adding to the complexity of the issue.

From Foghorn to Lifesaver: Recognizing the True Alarm of Snoring

Instead of dismissing snoring as a mere annoyance, it is crucial to view it as a warning signal. In fact, in some cases, snoring can serve as a safety mechanism when the bed partner senses a potential problem and wakes the snorer. Merely treating the snore without addressing its root cause, such as airway obstruction, fails to provide an effective solution. Therefore, any oral appliance designed to alleviate snoring should aim to eliminate the underlying obstruction responsible for the snore itself.

The Urgent Need for Sleep Testing

In today’s medical landscape, diagnostic tests are readily available for various health conditions, from cancer to heart problems. However, the screening for sleep issues, particularly sleep apnea, remains outside the realm of insurance coverage. This must change, as a definitive diagnosis and tailored treatment plan cannot be determined without proper testing. There is an undeniable link between sleep apnea and other significant health conditions which demands that sleep testing becomes an essential part of mainstream medical practice. We offer home sleep studies at The Julian Center to evaluate your sleep in the comfort of your home.

Deep Sleep and Its Vitality

Contrary to societal beliefs, sleep is not a luxury but a necessity for human survival. Just like every mammal, humans have sleep cycles ingrained in their biology, demonstrating the evolutionary importance of sleep. Going without sleep can have severe consequences, as evidenced by the world record for voluntary sleep deprivation of eleven days, which left the individual in a near-vegetative state. Studies on rats have shown that two weeks without sleep can be fatal, further emphasizing the critical role of sleep in maintaining overall health.

Snoring, often overlooked and dismissed as a trivial matter, is a genuine health concern. The undeniable link between snoring, sleep apnea, and potentially life-threatening illnesses demands immediate action. By raising awareness, encouraging sleep testing, and providing effective treatment options, we can save lives and ensure a healthier future for all. It is time to acknowledge the foghorn in the night and take active steps towards a well-rested, healthier tomorrow.

Unlocking the Secrets of the Sleep Cycle: The Key to a Rested Brain and Body

Embark on a journey through the fascinating world of sleep, where the brain recharges, and expels toxins, and memories are consolidated. Delve into the intricate stages of the sleep cycle, understand the significance of REM sleep, and explore the wonders of brain activity during this essential process. Discover the consequences of disrupting the sleep cycle, especially the debilitating disorder known as sleep apnea.

The Sleep Cycle: A Symphony of Restoration

Did you know that a complete sleep cycle typically lasts around eighty to one hundred minutes? From the initial entry into Stage 1 sleep to the rejuvenating REM stage, and back again, the cycle repeats throughout the night. For adults, experiencing the sleep cycle four to five times is crucial for feeling truly rested. Failure to enter REM sleep during each cycle can leave you feeling groggy and fatigued. Awakening before the end of a sleep cycle can also leave you groggy. REM sleep not only re-energizes the brain, but it also aids in the removal of toxins through the glymphatic system, while consolidating memories in Stage 2 (Non-Rem).

Unveiling the Brain’s Activity During Sleep

Scientists can observe the brain’s activity during sleep through the use of electroencephalograms (EEGs). These remarkable recordings display a chart of wavy lines resembling the activity monitors in a hospital. By attaching electrodes to the head, an EEG captures and measures the brain’s electrical signals. The height and depth of the waves, known as amplitude, represent the brain’s activity, while the rate of occurrence, or frequency, indicates the closeness of the waves. When awake, the EEG displays short-amplitude, high-frequency waves. As sleep ensues, the waves increase in amplitude and decrease in frequency, transitioning from desynchronous (inconsistent) to synchronous (consistent) patterns.

Unlocking the Mysteries of Brain Waves

Throughout the day, the brain’s beta waves fluctuate because of the constant mental stimulation from various sensory activities. However, during periods of rest while awake, the brain’s waves become more consistent, known as alpha waves. These slower, higher amplitude waves are a stark contrast to the beta waves experienced during active wakefulness. As sleep progressively takes hold, brain waves slow down further, becoming increasingly synchronous. The brain transitions from alpha waves (Stages 1 and 2) to delta waves (Stages 3 and 4), and ultimately, theta waves, representing the deepest level of sleep. Remarkably, the brain remains active and rejuvenating during sleep, as evidenced by EEG patterns. The primary distinction during REM sleep is the temporary paralysis (atonia) of the body’s motor function, even though the brain waves resemble wakefulness.

The Enigma of REM Sleep and Dreaming

Stage 4 of the sleep cycle introduces us to rapid eye movement (REM) sleep, the stage where dreams occur. This explains why some individuals can recall vivid details of their dreams when awakened during or after REM sleep. Fortunately, during this stage, the body’s muscles become paralyzed, preventing the acting out of dreams. However, there have been exceptional cases of parasomnia, where individuals have carried out their dreams, leading to legal complexities. It is within REM sleep that the brain regenerates and consolidates memories, allowing for a deeper understanding of our experiences.

The Profound Importance of Sleep: Cell Regeneration and Memory Consolidation

Recent studies highlight the primary purpose of sleep – regenerating cells and replenishing brain energy. Feelings of tiredness, irritability, lethargy, and depression stem from the brain’s inability to restore its depleted energy stores. Even if the body has rested, without proper brain rejuvenation, daytime functioning becomes challenging. Sleep also plays a crucial role in consolidating thoughts and memories from the day. Research has demonstrated that sleep enhances the conversion of short-term memories into long-term memories, significantly affecting our ability to learn and retain information.

Sleep Debt and the Role of REM Sleep

Energy depletion occurs during non-REM sleep stages (Stages 1, 2, and 3), inducing the brain to build up a reserve and a need for REM sleep. Unfortunately, sleep debt, resulting from a chronic lack of sufficient sleep, disrupts this process. If someone stays awake for an extended period, they will not immediately enter REM sleep. Non-REM sleep is necessary to accumulate the need for REM sleep. However, severe sleep deprivation can occasionally lead to direct entry into REM sleep, though this is an exception rather than the rule. Interestingly, experiencing sleep debt can lead to deeper sleep in Stage 2 (delta), compensating for the deficit.

The Crucial Role of REM Sleep in Restoring the Body and Brain

It’s not the overall time spent in bed that matters; the key lies in obtaining sufficient quality REM sleep. Unlike other parts of the body, such as muscles and organs, the brain has a unique and fascinating way of obtaining energy. While the rest of the body can rely on the reserves of fat and proteins, the brain solely depends on glucose for fuel. This distinct characteristic sets the brain apart functionally from the rest of the body.

The brain’s insatiable need for glucose is primarily driven by its intricate network of neurons. These tiny cells constantly communicate with each other, forming connections and pathways that enable us to think, learn, and perform various cognitive tasks. To sustain this complex web of activity, a constant supply of glucose is required.

Interestingly, the brain’s demand for glucose remains high even during sleep, particularly during the Rapid Eye Movement (REM) stage. This is the phase of sleep associated with vivid dreams and increased brain activity. During REM sleep, the brain’s activity levels are comparable to those when we are awake, leading to a surge in glucose consumption.

To meet the brain’s continuous need for glucose, the bloodstream plays a crucial role. It acts as a delivery system, ensuring a steady supply of glucose reaches the brain. This constant flow of glucose allows the brain to function optimally and maintain its remarkable capabilities. The reduction of glucose availability can lead to hypoglycemia and cause you to awaken.

Sleep apnea is a condition that disrupts the normal sleep cycles and can have detrimental effects on brain health and overall well-being. When a person with sleep apnea enters Stage 3, the shift to REM sleep can abruptly awaken them. This can occur because of their snoring or an obstruction in their airway, leading to a buildup of carbon dioxide. Instead of experiencing rejuvenating sleep cycles, individuals with sleep apnea stop breathing for ten seconds or more, multiple times an hour. This interruption in breathing not only affects brain health and energy but also deprives the body’s cells of oxygen, resulting in various health issues.

Demystifying the Mortal Risks of Excessive Stress

One of the key consequences of sleep apnea is the release of excess cortisol and adrenaline, commonly known as stress hormones. Having an excessive amount of these hormones in the body can have significant negative effects. Constantly elevated cortisol levels because of stress can lead to the breakdown of bodily systems. Individuals may find themselves constantly in a state of heightened alertness, commonly referred to as the “fight or flight” response, or in a state of freeze.

The cortisol hormone should follow a natural cycle, with the highest levels in the morning and gradually decreasing throughout the day. However, in individuals affected by stress, cortisol levels are lower in the morning, causing them to feel lethargic. They often rely on stimulants like coffee to kick start their day. At night, when cortisol levels should be at their lowest, these individuals struggle to fall asleep, making them stay awake for hours. This disruption in the cortisol hormone cycle is because of the stress placed on the adrenal glands, small organs that regulate hormones in the body. When constantly under stress, the adrenal glands become overworked, leading to adrenal fatigue or exhaustion.

Stress can also activate certain “switches” in the body, making typically healthy cells susceptible to disease. These switches are part of the autonomic nervous system, which consists of the sympathetic and parasympathetic divisions.

The sympathetic nervous system triggers the “fight or flight” response when faced with real or perceived danger. This response involves the release of cortisol and adrenaline, causing an increased heart rate and blood flow to the muscles. Even if the danger is not real, the body reacts as if it were in a life-threatening situation. For example, if someone’s airway becomes constricted during sleep, their sympathetic nervous system will activate the flight-or-fight response, waking them up as they gasp for air. With sleep apnea, these episodes of waking up due to choking occur throughout the night, leading to fatigue the following day.

Post-traumatic stress disorder (PTSD) experienced by soldiers returning from war is a result of having their sympathetic nervous system switched on for extended periods. A soldier in a war zone may find it difficult to fall asleep, causing their sympathetic nervous system to constantly release stress hormones. This continuous activation drains the adrenal glands of their ability to function properly, preventing the body from reaching a stable and constant internal state. People with PTSD often have vivid dreams, struggle to differentiate dreams from reality, and experience disrupted sleep patterns. A sympathetic state may be advantageous on the front lines in a war, but not in everyday life.

The Importance of a Balanced Nervous System

The goal is to maintain a balance between the sympathetic and parasympathetic nervous systems. When these systems achieve balance, the parasympathetic nervous system, also known as the rest-and-digest system, actively functions during sleep. It slows down the heart rate, aids digestion, and promotes muscle relaxation. The parasympathetic nervous system consists of two parts: the reptilian PNS and the mammalian PNS. The reptilian PNS causes a freeze response, while the mammalian PNS puts the body in a relaxed and mindful state, activating the sympathetic response during emergencies.

Both the sympathetic and parasympathetic nervous systems perform opposite functions in the same areas of the body, maintaining balance and homeostasis. Achieving and maintaining this balance is crucial for overall health and well-being.

When the body constantly experiences stress, it compromises its ability to maintain homeostasis. Homeostasis is the body’s natural ability to heal itself without any external intervention. However, when sleep disturbances disrupt this delicate balance, individuals often turn to medical intervention, such as the utilization of blood pressure medication to address hypertension (high blood pressure). This creates a vicious cycle that professionals can effectively remedy by addressing the underlying sleep disorder.

Sleep Disorders Demystified

There are several sleep disorders that individuals can experience, one of which is central sleep apnea. In central sleep apnea, the brain cannot regulate the breathing patterns during sleep. This means that individuals struggle to breathe not because of airway obstruction, but because of a disruption in the central nervous system. The brain, which has an electrical connection to the lungs, fails to send signals to the body to take a breath when carbon dioxide builds up. As a result, individuals with central sleep apnea forget how to breathe. This condition requires the expertise of a qualified neurologist to address.

At the Julian Center, our focus is on treating obstructive sleep apnea, snoring, and bruxism. Obstructive sleep apnea occurs when the airway is partially or fully blocked by the base of the tongue, causing individuals to choke. Our treatment approach involves repositioning the tongue by either pulling the jaw forward or expanding the arches to create more space for the tongue. Additionally, we utilize myofunctional therapy to retrain proper tongue posture. This treatment not only reduces snoring and bruxism but also alleviates the symptoms of sleep apnea.

Another sleep-disordered breathing issue is upper airway resistance syndrome (UARS). With UARS, individuals experience reduced airflow to the body because of a constriction in the upper airway. This condition, which commonly affects non-overweight patients, especially women, falls between snoring and sleep apnea in terms of severity. Sleep studies, which are used to diagnose sleep apnea, may not detect upper airway resistance or other sleep-disordered breathing issues.

The apnea-hypopnea index (AHI) measures the severity of sleep apnea, which counts the number of breathing disruptions per hour or the drop of oxygen saturation by more than 4% (hypopnea). A pause or partial obstruction must last at least ten seconds to be considered. Currently, fewer than five pauses per hour is considered normal breathing, while five or more pauses per hour indicate the presence of sleep apnea. However, the insurance industry rarely provides coverage for upper airway resistance with fewer than five events per hour. A properly reviewed home sleep study can evaluate the number of times you stop breathing vs. hypopnea.

We can categorize insomnia into three types. 1. Difficulty falling asleep, 2. Waking up and being unable to fall back asleep, and 3. Waking up feeling fatigued despite sleeping through the night. The connection between insomnia and sleep apnea lies in the different types of insomnia experienced.

  • In the first type, obstructive sleep apnea may not be the issue as individuals either never fell asleep or their sleep was fragmented.
  • The second type, where individuals fall asleep but wake up unable to go back to sleep, often indicates obstructive sleep apnea. The decrease in oxygen levels triggers arousal, leading to the release of adrenaline and cortisol, making it difficult to fall back asleep.
  • Sleep apnea may cause the third type, where individuals sleep through the night but feel unrefreshed in the morning. However, other factors may also contribute to this feeling of fatigue, which is outside the scope of this article.

Our integrative approach at the Julian Center addresses the components of sleep to ensure that we effectively treat every issue. This approach may also involve the expertise of a Board Certified Sleep Physician.

The CPAP Machine, Effective, But Not Well Tolerated

The most commonly recommended treatment for sleep apnea is the use of a continuous positive airway pressure (CPAP) machine, which delivers oxygen through the airway. However, compliance with CPAP usage is notoriously low, with reports indicating noncompliance rates between 30-40 percent. People often cite the discomfort associated with the mask as a key reason for noncompliance. Other factors include dry nose and sore throat, nasal congestion, facial irritations, reduced intimacy, and troublesome noises from ill-fitting masks that disturb bed partners. Additionally, the inconvenience of traveling with a CPAP machine further contributes to noncompliance rates. Also, the largest manufacturer of CPAP machines had a major recall because of potential health risks.

In conclusion, addressing sleep disorders such as snoring and sleep apnea is crucial for restoring the body’s ability to heal and maintain homeostasis. At the Julian Center, our professional approach focuses on providing effective treatments for these sleep disorders, ensuring that individuals can achieve restful and rejuvenating sleep.

Exploring Effective Treatment Options

Sleep apnea affects a staggering number of individuals, with approximately 18 million American adults suffering from obstructive sleep apnea, as reported by the National Sleep Foundation. This condition not only results in daytime sleepiness but also poses significant health risks because of the lack of sufficient oxygen intake during sleep. Recognizing the severity of this issue, it is imperative to explore alternative treatment options beyond the commonly used CPAP machine. This article aims to shed light on a more comfortable and convenient solution for managing sleep apnea: the intraoral appliance.

Understanding the Mechanism

While the CPAP machine acts as a valuable but often disliked remedy by providing oxygen during sleep, it does not alter the anatomy of the airway. In contrast, an intraoral appliance opens the upper airway, facilitating the smooth flow of air from the nose to the back of the throat, through the windpipe, and finally into the lungs’ air sacs. The CPAP machine offers some airway dilation through forced air pressure, preventing collapse. However, long-term use may decrease its effectiveness, potentially because of the pressure it exerts on the jaws, further narrowing the airway space, as well as drying out the nasal passage and back of the throat.

Choosing the Right Solution

Imagine being underwater and attempting to breathe through a tube: would you prefer a straw or a snorkel tube? While a CPAP machine effectively forces air down a constricted airway, making it suitable for severe sleep apnea, its discomforts often deter consistent usage. In contrast, the compliance rate with an intraoral appliance is significantly higher, around 90%. This device not only opens the restricted airway during use but also offers the flexibility to wear it during various activities such as driving, watching television, household chores, or even exercise.

The Julian Center Advantage

At the Julian Center, our fabricated intraoral appliances come with personalized coaching to enhance compliance and adherence. Recognizing that transitioning to this alternative may pose challenges for some individuals, our support aims to ease the process. Many users quickly adapt to the intraoral appliance, experiencing improved breathing, enhanced energy levels, and reduced disturbances for their bed partners.

Snoring: More than a Mere Annoyance

It is important not to dismiss snoring as a mere annoyance, as it can indicate underlying health issues. Ignoring potential sleep apnea symptoms can have serious consequences. If you or someone you know snores, it is crucial to address the matter promptly. In an upcoming article, we will explore the pros and cons of various available treatment options for sleep apnea, ensuring a comprehensive understanding in order to make an informed decision.

Sleep apnea affects millions of individuals, and its implications extend far beyond daytime sleepiness. The use of a CPAP machine, while effective, may pose discomforts that impede consistent usage. Alternatively, the intraoral appliance offers a more comfortable and convenient solution, with a higher compliance rate and the ability to open the restricted airway during use. Taking into account the benefits of this innovative approach, it is essential to consider alternative treatment options for managing sleep apnea effectively.

An additional treatment option, especially for snoring, is NightLase therapy. This involves a non-ablative laser to heat the soft pallet, resulting in an increase in collagen and tightening up the tissue to prevent blockage of the airway.

Next Article: Part 7-Revealing the Latest Innovations in Sleep Apnea Diagnosis and Treatment

Return to 10 Part Compilation

RELATED

 JULIAN CENTER FOR

 EFFORTLESS SLEEP

           5012 Dorsey Hall Drive , Suite 205
           Ellicott City, MD 21042

           Get Directions

Tel: (410) 964-3118
Fax: (410) 964-3154

Mon: 9am – 5pm
Tue – Thur: 8am – 5pm