PIC

The term SDB encompasses a wide range of breathing disorders that occur during sleep.  Snoring and Obstructive Sleep Apnea (OSA) is the cause of most frequent SDB visits to the doctor's office.   Snoring and Obstructive Sleep Apnea will be discussed here. 

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Sleep Physiology and the Upper Airway

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Have you seen anyone snore when they are awake?  Chances are you haven't.   Outside of uncommon situations, snoring and throat blockage does not occur when a person is awake.  The dilators muscles in the upper portion of the airway called the pharynx is affected by various pressure, CO2, and neural pathways to maintain the patency of pharynx when awake.  With few exceptions, even patients with rather significant OSA have normally active ventilatory control systems that maintain normal breathing and oxygenation when awake.  In fact, some OSA patients with a small pharynx have a heightened, more stimulated upper airway controls that keep their narrow throat open when they are awake. 

 

Simply put, the muscle tone in the throat is elevated during awake periods to keep the airway open during awake activities.   During sleep, there is relative loss of muscle tone in the pharynx as well as the tongue.  If the size of the airway still remains sufficiently open, breathing is unimpaired.  If it's significantly collapsed then snoring may occur due to fluttering and vibration in the throat.  Snoring can drive the bed partner nuts or can even wake the patient from their own noise. 

 

If the throat narrowing is more severe, Obstructive Sleep Apnea (OSA) can result. 

Nearly all patients with OSA snore.  Apneic or hypopnea spells maybe observed by the bed partner where a person seems to be suffocating with their chest and abdomen moving trying to breathe but little to no air is coming in and out of their nose and mouth.  They are essentially choking on their own collapsed throat.  Body's oxygen level falls.  Ultimately, fail safe mechanism that sacrifices normal sleep for survival kicks in and breathing resumes as they are "aroused" to a lighter level of sleep.  Harmful physiologic changes occur during those events that stress the heart and the cardiovascular system. 

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Resultant sleep fragmentation (irregular sleep due to breathing events) and physiologic stress leads to problems associated with OSA.

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Causes of Nasal Obstruction or Congestion

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Temporary causes for nasal congestion includes:

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• Common cold or the flu

• Allergic and non-allergic rhinitis

• Environmental irritants, such as smoke or dust

• Sinus infection

• Cold or flu

• Certain medications, (examples are some high blood pressure medicines and ED drugs like Viagra

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Chronic nasal congestion causes are often Structural-Anatomic and includes:

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• Deviated Nasal Septum (the wall separating the two nasal cavities)

• Enlarged Turbinate (bony structures on the side of the nose lined by mucosa/tissue)

• Nasal Valve Collapse or Narrowing

• Adenoid tissue enlargement

• Polyps and Tumors (majority are benign but some are cancerous)

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Chronic nasal congestion may cause

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• Fatigue

• Decrease in productivity

• Depression, irritability, mood swings

• Poor sleep quality

• Dental decay

• Negatively impacted quality of life

• Difficulty tolerating CPAP or Oral Appliance for treatment of Sleep Apnea

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Nasal Obstruction and Snoring

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Nasal congestion may also contribute to snoring.  When the nose is congested, the demand for air causes you to breathe through your mouth.  Mouth breathing causes turbulence and due to increased negative pressure behind the soft palate, fluttering occurs which can cause or worsen snoring. 

A study conducted by the University of Wisconsin Sleep and Respiratory Research Group found that nasal obstruction led to increased sleep