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Snoring is no laughing matter

Dr. Steven Smart February 12, 2009 10:30 AM This chat has ended. Thank you for participating.
Dr. Steven Smart (NorthShore) - 10:25 AM:
Good morning and welcome to the chat on NorthShore.org. I look forward to answering any questions you may have about sleep apnea.

Scott Williamson (Skokie, IL) - 10:31 AM:
I am spending quite a bit of time sleeping on the couch as a result of my snoring. My wife is annoyed yet afraid because she feels that I am just going to stop breathing one night. She claims that I take "time-outs" breathing while I sleep and then have a loud and violent recovery when I start again. I am probably 25 - 30 lbs. overweight but I believe that this was an issue even before that. What are my options?

Dr. Steven Smart (NorthShore):
Snoring that causes people to sleep in separate rooms is serious enought that it should be evaluated. It is often a marker of severe sleep apnea which can significantly increase your risk of heart attack, stroke and sudden death. It can also aggravate hypertension and obesity. I would strongly recommend you consider contacting our sleep center or the sleep center of your choice for further evaluation. http://www.northshore.org/clinicalservices/sleepcenter/

John (Chicago, IL) - 10:33 AM:
What effect does Sleep Apnea have on your heart?

Dr. Steven Smart (NorthShore):
Sleep apnea increases the stiffness and thickness of the heart. The pressure the heart is exposed to dramatically increases. The chemicals of stress in your body dramatically increase. The result is increased risk for rhythm disturbances of the heart, heart failure, heart attack, stroke and hypertensive injury to kidney and other organs. It is a severe aggravating factor for people with hypertension.

Al (Mundelein, IL) - 10:35 AM:
what is the relationship between snoring and being over weight?

Dr. Steven Smart (NorthShore):
There is a significant relationship between snoring, sleep apnea and weight. Men with neck size above 18 and women with neck size above 16 are significantly higher risk for severe snoring and sleep apnea. Central sleep apnea or your brain causing your brain causing your breathing pattern to decrease is not assoicated with weight, but is more associated with chronic lung and heart disease.

Anna Swindle (Evanston, IL) - 10:37 AM:
Hi, Dr. Smart. I'm a graduate journalism student at Northwestern and I'm writing an article about sleep apnea. Since obesity is on the rise in America, have you noticed a significant increase in the number of sleep apnea cases you see?

Dr. Steven Smart (NorthShore):
We have noticed a dramatic increase in sleep apnea cases. Five years ago it was stated that between 5 and 10 percent of heart disease patients may have sleep apnea. Now the percentage may be as high as 45 to 55 percent. We are now finding the effects of sleep apnea on the heart commonly during screening stress tests. It is very important to screen for the combination of sleep apnea and heart disease because the risk of heart-related death may be eight times the normal population.

Suzanne Meyering (Chicago) - 10:39 AM:
Are sleep apnea and fainting related?

Dr. Steven Smart (NorthShore):
Yes, but loosely. Sleep apnea causes severe sleep deprivation and may cause fainting due to sleep attacks. It may also cause fainting due to heart arrhythmias. It also aggravates hypertension and your risk of mini-strokes which may present as fainting.

Anna Swindle (Evanston, IL) - 10:41 AM:
And, as a follow up question, if a person has weight-related sleep apnea and then loses weight, will the apnea often go away?

Dr. Steven Smart (NorthShore):
We have found that CPAP therapies and treatments for sleep apnea can stabilize the disease. You are correct in your assumption. Weight loss is the most sure way to reverse the disease process, correct the obstructive process and treat the dangerous effects on heart disease.

Rich (Park Ridge, IL) - 10:42 AM:
Good Morning. Does Apnea ever improve or go away?

Dr. Steven Smart (NorthShore):
Yes, please see the previous answer. Dramatically changing your body type, losing weight and changing your lifestyle can dramatically change sleep apnea.

Shelly (Glenview, IL) - 10:43 AM:
What are some other causes of snoring? Are they life threatening?

Dr. Steven Smart (NorthShore):
Other causes include upper airway obstruction due to enlarged tonsils, traumatic injury to the cervical spine, head injuries, sinus and palate problems. The major cause remains obstructive sleep apnea and narrowing of the airway and enlargement of the base of the tongue.

John (Chicago, IL) - 10:45 AM:
How do your heart muscles react to a person with sleep apnea? What are the short term and long term effects?

Dr. Steven Smart (NorthShore):
Short-term sleep apnea dramatically lowers your blood oxygen and raises the blood pressure effects on the heart. If your blood pressure is 150/80, an apnea episode causes your heart to be exposed to pressures of 250/180. The acute effect is a dramatic increase in stress on the heart and the stress hormones in your body. Long-term, the net effect is thickening of the heart, stiffening of the heart, constriction of blood vessels, increased pressure in the lungs causing high-risk for heart failure, heart attack, stroke, atrial fibrillation, sudden death, kidney disease, accidents, major injuries and sleep deprivation related consequences.

Tim (Waukegan, IL) - 10:48 AM:
What options are available to alleviate Sleep Apnea when exercise is not possible?

Dr. Steven Smart (NorthShore):
CPAP or pressurized breathing with a mask, aggressive diet and weight loss, mouthpieces that prevent the tongue from falling back on the throat, sleeping on your side, using devices that prevent sleep on your back, surgery that reduces the excess tissue surrounding the airway and tracheostomy in extreme cases. Sometimes tonsillectomy and correcting chronic sinusitis may also have beneficial effects.

Suzanne Meyering (Chicago) - 10:51 AM:
How important is sleep position--e.g., on back or side?

Dr. Steven Smart (NorthShore):
It is extremely important in many cases. We commonly see in sleep studies that apnea-related events are dramatically worse in supine position, or sleeping on your back. Sleeping on your side is part of good sleep hygiene and prevents the tongue from falling back and obstructing the airway. In certain severe cases, position has no affect, but the majority are significantly position related.

John (Chicago, IL) - 10:53 AM:
Is there a correlation between sleep apnea and high levels of ACT and ALT? If you have sleep apnea and high ACT and ALT, is that a sign of heart disease?

Dr. Steven Smart (NorthShore):
John, I believe you mean AST and that's a very good question. AST and ALT can be signs of muscle injury or, more commonly, liver disease. Indirectly these may be elevated in sleep apnea patients that have severe heart failure and severely elevated pressures in their lungs. It is often a sign of advanced disease. Most sleep apnea patients demonstrate no elevation in these markers.

Anna Swindle (Evanston, IL) - 10:55 AM:
Which gender or demographic (if any) is most at risk for sleep apnea?

Dr. Steven Smart (NorthShore):
It has been stated that sleep apnea is more common in men, but our experience is that there is no gender preference. It is most commonly associated with obesity irrespective of gender, high blood pressure, heart disease, nervous system disease, lung disease and chronic illness.

Anonymous - 10:57 AM:
How does snoring affect the heart?

Dr. Steven Smart (NorthShore):
A similar question was asked previously, here is my response: "Sleep apnea increases the stiffness and thickness of the heart. The pressure the heart is exposed to dramatically increases. The chemicals of stress in your body dramatically increase. The result is increased risk for rhythm disturbances of the heart, heart failure, heart attack, stroke and hypertensive injury to kidney and other organs. It is a severe aggravating factor for people with hypertension." Continuing, severe sleep apnea makes plaques in the arteries unstable and is likely the major cause of the spike in heart attacks and sudden death overnight and in the early morning hours. It dramatically impairs quality of life by stiffening the heart and dramatically increasing the amount of work the heart has to perform to pump blood through the lungs. The net effect is poor capacity and shortness of breath.

Christina (Chicago, IL) - 11:01 AM:
When I am on my machine and trying to fall asleep at night, I sometimes take it off because my heart is racing, why is this so?

Dr. Steven Smart (NorthShore):
Your racing heart is likely a consequence of the chronic affects of sleep apnea or a primary rhythm disturbance of the heart. CPAP often helps with this condition. If your symptoms are persistent or worsening I recommend you see your physician for further evaluation.

Suzanne Meyering (Chicago) - 11:02 AM:
Besides weight loss, does reducing cholestorol help alleviate sleep apnea?

Dr. Steven Smart (NorthShore):
Cholesterol has no direct effect on sleep apnea whereas weight loss has dramatic beneficial effects on sleep apnea.

Jacob (Chicago, IL) - 11:03 AM:
Is sleep apnea genetic?

Dr. Steven Smart (NorthShore):
There is strong familial association of sleep apnea. It's not clear if there is a direct genetic predisposition or an indirect affect of the genetic predisposition of body type and weight.

Anna Swindle (Evanston, IL) - 11:05 AM:
How effective are surgical options for sleep apnea, and who are the best candidates for surgery? Do you recommend it often?

Dr. Steven Smart (NorthShore):
The surgical options are often less effective in general sleep apnea patients. In patients who have dramatic anatomic problems with their airway, surgery may be especially beneficial. I do not recommend surgery very often. If you would like more info, it would be best to contact our sleep center @ 847.663.8200.

Rich (Park Ridge, IL) - 11:08 AM:
How is the range of CPAP air pressure determined for each person receiving that therapy?

Dr. Steven Smart (NorthShore):
The optimal pressure settings for CPAP are best adjusted during a sleep study. Again, please contact the sleep center @ 847.663.8200 for further recommendations.

Cindy (Lake in the Hills, IL) - 11:09 AM:
Hi doctor, does sleep apnea make it harder to control conditions such as high blood pressure?

Dr. Steven Smart (NorthShore):
Yes. Sleep apnea dramatically worsens blood pressure control and the effects of blood pressure on your heart, blood vessels, organs and lungs.

Jacob (Chicago, IL) - 11:10 AM:
With that said, is there a form of genetic testing that goes into diagnosing sleep apnea?

Dr. Steven Smart (NorthShore):
No. Sleep apnea is a mechanical consequence of too much tissue surrounding the airway or direct inappropriate relaxation of the airway muscles during sleep. Genetic testing would only be appropriate for conditions aggravating obesity and the muscle function of the airway.

Tim (Waukegan, IL) - 11:12 AM:
Are there other less-publicized, but serious sleep/health conditions that your center addresses?

Dr. Steven Smart (NorthShore):
Yes. Narcolepsy, insomnia, central sleep apnea (which is inappropriate brain regulation of breathing during sleep), sleep attacks, severe sleep deprivation. Please contact the sleep center @ 847.663.8200 for further information. Basically, any form of sleep disorder can be evaluated by the center.

Dr. Steven Smart (NorthShore) - 11:15 AM:
There are about 15 minutes left in the chat. If you have any more questions, please submit them now. The questions so far have been excellent.

Dr. Steven Smart (NorthShore) - 11:18 AM:
The interaction between sleep apnea and heart disease has recently been published from the Wisconsin Sleep Cohort. The risk of heart disease related death and other problems is increased 5-8 times by sleep apnea. Heart disease accounts for 25-30 percent of deaths in the normal population. In severe sleep apnea patients heart disease and stroke account for greater than 70 percent of the deaths. It is imperative that every patient with severe sleep apnea be screened at your doctors discretion for heart disease. Early detection of heart, vascular and heart-lung disease may be the only way to reduce these devastating consequences.

Jacob (Chicago, IL) - 11:19 AM:
What are the risks of untreated or undiagnosed sleep apnea?

Dr. Steven Smart (NorthShore):
Uncontrolled high blood pressure, atrial fibrillation, heart failure, heart attack, stroke, sudden death, kidney failure, poor quality of life and very frequent health problems.

Anna Swindle (Evanston, IL) - 11:20 AM:
Is sleep apnea the most common sleep disorder? If not, what is?

Dr. Steven Smart (NorthShore):
Obstructive sleep apnea is probably the most common sleep disorder. The rise in incidence of chronic heart-lung disease and kidney disease has caused significant increase in central sleep apnea. Many patients now have both central and obstructive sleep apnea. Narcolepsy is a less common disorder. Insomnia is another extremely common condition which may be hard to quantify. Restless leg syndrome is another common sleep condition and may be a significant marker for sleep apnea.

Bill (Chicago, IL) - 11:22 AM:
How do you know if you have sleep apnea if there's no one around to tell you? I have irregular sleep but don't know why.

Dr. Steven Smart (NorthShore):
You can screen yourself for sleep apnea by the consequences of sleep apnea including falling asleep when watching television, falling asleep when driving, falling asleep during conversation, chronic fatigue, heart symptoms of irregular heartbeat, shortness of breath, chest pain, declining capacity. The other screening symptoms can be restlessness at night, frequent trips to the bathroom at night, restless legs, changing positions, feeling tired when you wake up, weight gain, worsening blood pressure, confusion and memory loss/cognitive problems.

Suzanne Meyering (Chicago) - 11:26 AM:
Are deviated septum and sleep apnea related?

Dr. Steven Smart (NorthShore):
There is some relationship. A deviated septum will aggravate the obstruction in patients with underlying airway problems and obesity.

Chris (Northfield, IL) - 11:27 AM:
How do you determine if there is damage to the heart from sleep apnea?

Dr. Steven Smart (NorthShore):
The only way to determine if your heart, lungs or other organs have been damaged is an evaluation by your physician.

Kristin (Moderator) - 11:28 AM:
Dr. Smart has time for one last question today.

Suzanne Meyering (Chicago) - 11:29 AM:
Does practicing yoga improve night time breathing?

Dr. Steven Smart (NorthShore):
Yoga can potentially improve sleep hygiene but it has no proven affect on sleep apnea.

Kristin (Moderator) - 11:29 AM:
Thank you again to everyone for joining us today. If you have any more questions, please visit our Sleep Apnea resources on the website for additional information.

Dr. Steven Smart (NorthShore) - 11:29 AM:
I'd like to thank all of you for participating. For more information about sleep apnea and heart disease please contact my office @ 847.663.8410 or call the NorthShore University HealthSystem Sleep Center @ 847.663.8200. Thank you for your interest in this very important topic of sleep apnea and heart disease.
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