MEN IN BED: SNORING
Waking up grumpy. Under a microscope, tissue taken from the throat of a man who snores looks just like tissue taken from the hands of a man who regularly uses a jackhammer. It is slack and floppy. All the muscle tone has been vibrated out of it. Snoring makes the soft palate at the back of the mouth vibrate. The more a man snores, the more the palate vibrates and the weaker it becomes. The more it weakens, the harder it is to stop snoring.
It is this progressive loss of tone that can turn a mild snorer into a man with a chronic sleep problem. Over a few decades, it can also turn a relatively nice bloke into a grumpy old man. Grumpy because, without even knowing it, he has not had a decent night’s sleep in years.
Until recently, snoring has been largely ignored. It’s been viewed as an innocuous activity which, at worst, irritates the snorer’s sleeping partner. The insidious damage it causes and the resulting ramifications are only now being fully recognized.
Heavy snoring puts tremendous stress on the body. It generates a huge amount of pressure in the throat and can transform sleep from a restful activity into a struggle for oxygen. The development of new technology in the 1970s showed that snoring has the potential to reduce blood oxygen to levels that were previously thought incompatible with human life.
Chronic heavy snorers often have episodes of apnoea when the soft palate and the tongue relax, due to decreased muscle control, and fall back in the throat, effectively blocking the flow of air in and out of the lungs. When this happens the man chokes and the oxygen level in his blood falls dramatically. An automatic reflex usually jerks him into restarting breathing. During such episodes the oxygen level can drop 80 per cent. Repeatedly these men get a fall in oxygen levels equivalent to going up to the top of Mt Everest and back in twenty seconds. Men with chronic sleep apnoea do this hundreds of times a night.
These repeated falls in oxygen have long-term effects on health. Simply having a history of heavy snoring is associated with an eightfold increase in the risk of stroke, double the risk of high blood pressure and an increased risk of heart attack, probably as high as twentyfold. Throat tissue damage can become evident after just five or ten years of snoring. Even in the early stages, the tissue can become so loose that sleeping becomes a night-long battle to breathe. This can happen without the man even being aware of it. All he knows is that he doesn’t feel restored on waking and that during the day he feels sleepy and performs under par.
Men are more prone to snoring than women. Until the age of fifty, about nine men snore to every one woman. After this, the gap begins closing. It is believed that androgens (male hormones) amplify snoring. Men have a lower voice, their throat tissue is floppier, and their larynx vibrates at lower frequencies. At menopause, women’s hormonal balance changes, androgens rise and so does their predisposition for snoring.
Snoring is not inevitable. It is not something men have to resign themselves to. If recognized early it can be stopped. There are several things even an established snorer can do to minimize it. Sleeping on the side rather than the back is recommended. Keeping weight down is crucial. For many men there is a weight threshold above which they will snore. Often a very small amount of extra weight can make a big difference.
Alcohol is a muscle relaxant and relaxes the throat muscles, making snoring all the more likely, so the consumption of alcohol in the last few hours before going to sleep should be avoided. Nasal obstructions, such as allergies or old football injuries, also can lead to snoring and should be treated.
General fitness helps, too, but there are exceptions. Weightlifting or sports which build thick neck muscles can encourage snoring by putting pressure on internal airways. Genetic inheritance is influential as well. Some men are just born with narrow airways and will become snorers. Those with long necks are less predisposed. Giraffes are unlikely to snore, and looking at Nefertiti, it would be a fairly safe guess that she never snored either.
It is when moderate snoring progresses to heavy snoring and incidents of sleep apnoea begin that the activity becomes dangerous. Studies have shown that 25 per cent of middle-aged men (between the ages of forty and sixty) have an average of five apnoeas per hour of sleep. This is regarded as mild apnoea and most men would not know they had it. Men who suffer chronic sleep apnoea may have between 300 and 500 incidents a night. Over time the lack of good sleep begins to show. Signs of personality change emerge, the men feel grumpy and irritable, their short-term memory starts going, and so does their libido.
Treatment for chronic sleep apnoea includes various types of surgery or using a special mask which was developed in the 1980s by Professor Colin Sullivan, respiratory physician at the University of Sydney. This mask has since become the international ‘gold standard’ for treatment. Lasers are also used to operate on the throat to stop snoring.
If you think you suffer from sleep apnoea and need treatment, first see your local doctor. The doctor can then refer you to a respiratory physician who will decide if you need to go to a sleep laboratory.
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