Sleep Disorder FAQ’s

Bellin has provided the following questions and answers to help you better understand what sleep issues might be affecting you or a loved one.

What causes snoring?

Snoring is the sound made by air passing through irregularities and narrowing in the throat and windpipe. Snoring can occur when someone breathes in or breathes out. Snoring in itself is not dangerous, but it can be the first stage in the development of apnea. Weight gain, sedation or anything else that further constricts the upper airway could turn a chronic snorer into a sleep apnea patient. Also, there is some data to suggest that chronic and severe snoring may lead to high blood pressure and cardiac changes.

When my husband sleeps, he stops breathing for a few seconds and starts again with a loud snort. The family used to laugh at the noise he made. But now I am so bothered by the noise that I lay awake worrying that he might forget to breathe and die. Am I being silly?

No. What you describe is sleep apnea (cessation of breathing during sleep). The body controls breathing differently during sleep, and in your husband’s case the control is not working correctly during sleep. He should be evaluated at a sleep disorder center. He may require treatment with CPAP, a dental device, or even an operation. Other signs of sleep apnea are daytime fatigue and sleepiness, morning headache, obesity and high blood pressure.

What are the signs of sleep apnea?

The most common signs are loud, irregular snoring and daytime sleepiness. The apnea comes from the walls of the airway closing on inspiration during sleep. The patient struggles for air, the airway opens somewhat and air rushes in causing loud snoring. The patient may toss and turn but often goes right back to sleep. This cycle can be repeated hundreds of times throughout the night, each time disrupting sleep and contributing to the patient’s excessive sleepiness during the daytime.

Can sleep apnea be dangerous?

It can be serious if it is combined with any significant heart problems and reduction of the oxygen levels in the blood. If, as a result of apnea, a patient falls asleep inappropriately during the daytime, it puts the person at greater risk for car accidents or work-related accidents. Consider the potential harm if, for example, a pilot or a school bus driver falls asleep on the job.

What causes apnea?

The most important single factor is narrowing at one or more points in the airway. The narrowing may be no problem at all during waking hours. During sleep, because of changes in the way breathing is regulated and because we are usually lying horizontally, the narrowing may lead to sleep apnea. Narrowing can be anywhere along the airway from the back of the nose and throat (nasopharyngeal airway) to the point where the wind pipe (trachea) divides into the two tubes (bronchi) leading to the lungs. Narrowing could stem from hereditary influences in the way the body’s bones and muscles grow. Narrowing can also result from fat deposits or a tumor around the walls of the airway. These anatomical problems act to partially reduce the size of the airway.

Probably the most common reason for sleep apnea is extra tissue in the oropharyngeal airway—the spot between the base of the tongue and the Adam’s apple. Such extra tissue is common in overweight men with short, muscular necks. The extra tissue around the face and neck reduces the opening in the airway available for breathing. Often, patients with sleep apnea are men in their 40’s or 50’s who are overweight, have a short, muscular neck, and display a history of snoring and progressively worsening sleepiness. However, women suffering from sleep apnea often go undiagnosed because they don’t fit the mold of the “typical” patient.  Abnormalities of the jaw and chin, such as a large overbite or a receding chin, may also lead to sleep apnea as they displace tissues to the back of the airway.

Alcohol and sedatives, by depressing the central nervous system and relaxing the airway muscles, can also be contributing factors. Age can also play a part. Often older people snore more, presumably because the airway tissues are limper and therefore more likely to narrow during intake of air.

Many mornings I wake up with a headache. I am not a drinker. What can cause this?

There are many reasons why someone might wake up with a headache. People with sleep-related breathing disorders do not get enough oxygen in their blood during the night and may awaken with headache and grogginess.

When should someone consult a specialist for a sleep problem?

There is no perfect answer to this question. A good rule of thumb is to see a specialist if your sleep problem persists for a month or more despite following your doctor’s advice and prescriptions. However, you should get expert help immediately if you have experienced dangerous symptoms such as (a) waking up with chest pain and/or shortness of breath, (b) falling asleep at an inappropriate time such as while enjoying a party or while driving a car.

How do I find a specialist in Sleep Disorders?

Specialists in sleep disorders medicine are physicians with a staff and a laboratory for diagnosing and treating patients with all sleep-related disorders. The disorders include difficulties in falling asleep, staying asleep or remaining awake. The most serious symptoms of sleep disorders are daytime sleepiness, excessive use of sleeping pills, nighttime chest pain, morning headaches, heavy snoring and breathing irregularities during sleep. Diagnostic and treatment services are provided by professionals experienced in sleep related and sleep-exacerbated diseases. Other physicians with expertise in neurology, pulmonary medicine, psychiatry and psychology are always available to the sleep disorders specialist.

What are some of the treatment options for sleep apnea?

There are three modes of interventions for the treatment of obstructive sleep apnea:

  • Behavioral Interventions:
    • Lose weight
    • Avoid alcohol and sedatives
    • Avoid sleep deprivation
    • Avoid supine (back) sleep position
  • Medical Interventions:
    • Continuous Positive Airway Pressure (CPAP)
    • Bilevel Positive Airway Pressure (BiPAP)
    • Oral appliances
  • Surgical Interventions:
    • Reconstruct upper airway
      • Uvulopalatopharyngoplasty (UPPP)
      • Laser-assisted Uvulopalatopharyngoplasty (LAUP)
      • Genioglossal Advancement
      • Maxillomandibular Advancement
      • Nasal operation
      • Tonsillectomy
    • Bypass upper airway
      • Tracheostomy

At the end of the day, my legs often feel jumpy or anxious. Sometimes my spouse complains that my legs are "kicking" all night long. What does this mean?

Restless Leg Syndrome (RLS) is an overwhelming desire to move one's legs. This usually occurs while at rest, later in the evening, or just prior to sleep onset. Adults with RLS often say the feeling is an uncomfortable, sometimes crawly feeling. Some people not only have this feeling in their legs, but also in their arms. To relieve the crawly feeling, people usually have to get up and walk around. Sometimes rubbing the legs brings relief.

There seems to be no concrete reason why some people have RLS and some do not. RLS can occur in the pregnant population, people with iron-deficiency anemia, post-gastrectomy surgery, and end-stage renal disease (ESRD). Family members can also inherit RLS.

Periodic Leg Movement Syndrome (PLMS) is periodic episodes of repetitive limb movements that occur during sleep and may occur all night long. These movements are associated with a partial arousal or awakening. The person is usually unaware of the twitching or sleep disruption; however, their bed partner will usually notice the movements.

PLMS can result in excessive daytime sleepiness. It can also produce anxiety and depression relating to the sleep deprivation.

What is narcolepsy?

The main characteristic of narcolepsy is overwhelming excessive daytime sleepiness (EDS), even after adequate nighttime sleep. A person with narcolepsy can become drowsy or fall asleep, often at inappropriate times and places. Daytime naps may occur many times a day with or without warning and be unavoidable. Drowsiness may persist for prolonged periods of time. In addition, nighttime sleep may be disrupted, with the person waking up periodically through the night.

What is insomnia?

Insomnia is characterized by an inability to sleep and/or to be incapable of remaining asleep for a sustained period of time. The root causes can include fear, stress, anxiety, medications, herbs, caffeine, an overactive mind or physical pain. Finding the underlying cause of insomnia is usually necessary to cure it.