Snoring woes could be deadly serious

By KATHERINE HOBY

It's a familiar story to many New Zealanders.

One partner snores while the other lies awake at night - pillow over head, occasionally prodding or shoving the offender, or stumbles, bleary-eyed, down the hall to the spare room.

Snoring and sleep apnoea are common problems in New Zealand but are not taken seriously, says Dr Andrew Veale, clinical director of the Auckland Physiology Sleep Laboratory.

"People with sleep apnoea do have an increased mortality risk. No doubt about that," he says.

"The public health service is woefully inadequate. If you are nodding off while driving it takes four to five months to get a sleep study done.

"I understand that it's hard to take money away from things for the new kid on the block, but this is being treated as a serious issue in other places, including Australia."

Dr Veale is a respiratory physician and has been working at the laboratory for seven years. He is a specialist in sleep and breathing.

He has two different types of patient - those who snore and those who are always sleepy.

People he sees range from "those who snore only when on their back and after having a skinful to those suffering frequent deep-sleep apnoeas".

Dr Veale says there are several predisposing factors for snoring.

Anyone with a nasal disease or nasal airflow obstruction is likely to be prone to snoring or sleep apnoea.

"If, when you take a breath in, it is like sucking through a blocked straw, then that is sucking your airway shut - and you'll be a snorer," he says.

Those with a flattened mid-face, such as Asians, tend to be snorers as the whole of the face, including the palate, sits nearer the back.

"Skeletal predisposition is quite a good predictor. If your dad snores and you look like your dad, you are in serious trouble."

People with a big tongue are more likely to keep their partners awake at night snoring.

Overweight or obese people have a bigger neck circumference and a much smaller airway, so obesity is also a predictive factor.

Alcohol acts as a muscle relaxant, which is why people who are intoxicated tend to snore.

Despite lifestyle factors such as smoking, alcohol intake and excess weight being highly influential, Dr Veale says few of his patients feel able to change their habits.

He says he has heard of every snoring remedy. Every remedy - from the old wives' tale of putting a ping-pong ball between snorers' shoulder blades to prevent their sleeping on their back, to laser surgery - works for some.

Throat sprays work for some because they are made of a detergent-like substance which stops the throat closing up and sticking, making the "snap" sound sometimes heard.

Other remedies include nasal strips, soft collars, dental devices and surgical techniques.

Some apnoea sufferers are hooked up to a continuous positive airways pressure device every night.

It is a rather drastic but effective measure which works by constantly forcing air into the wearer through a mouthpiece.

The first of the surgical options involves trimming the edge off the soft palate, including the uvula. This procedure can be quite painful.

"It works in a percentage of people but you have got to pick your case very carefully," says Dr Veale.

A laser surgery procedure, called laser-assisted uvulaplasty, involves making a burn of about 1cm across the midline of the soft palate.

As the scar heals, it causes some tissue shrinkage and stops the palate going floppy.

Dr Veale says the latest procedure, which he has been carrying out for about three years, is somnoplasty.

This is similar to the uvulaplasty as the desired result is a stiffening of the palate. An area of palate tissue is heated, and as the cells heated die and are removed by the body the palate shrinks and stiffens.

The technique is also used to shrink the back of the tongue.

Dr Veale says somnoplasty is expensive - between $1000 and $1200. Often several treatments are required, but it is a much less painful treatment than the other surgeries.

"If you're rich it's a reasonable thing to do but it has an unpredictable outcome," Dr Veale says. He cites a 60 to 70 per cent success rate.

Dr Veale says he has seen hundreds of snorers and their partners over his seven years at the laboratory.

"Snoring is something that gnaws away at relationships. I mean, it is not crash-bang destructive but it can have a big impact," he says.

Women often accompany their partners to consultations. Dr Veale says two-thirds to three-quarters of the snorers he sees are men.

Sixty per cent of men snore sometimes, and 9 per cent of middle-aged men snore and have some obstructive sleep apnoea.

Women are also the ones who often encourage their partner to seek some help, he says.

"Snoring can be treated as a joke or an embarrassment by some - but there is help available."

Dr Veale says we do get more sleepy as we get older and not everyone who snores develops sleep apnoea.

Two questions to ask if you suspect sleep apnoea - do you get tired at inappropriate times of the day? And do you wake up gasping for breath at times during the night?

It also depends what you perceive as normal, Dr Veale says.

"Because it can creep up on you slowly you forget what is normal. Some people I see think it's normal to feel tired and almost drop off mid-afternoon," he says.

"I asked a train driver having troubles recently: 'How often do you nod off?' 'I wake up on the corners,' he told me."

SNORING

Noisy breathing through the open mouth during sleep, produced by vibrations of the soft palate. It is usually caused by some condition that hinders breathing through the nose.

SLEEP APNOEA

Episodes of temporary cessation of breathing, lasting 10 seconds or longer, which occur during sleep. People who have sleep apnoea might not be aware they have a problem during the night, but they may be excessively sleepy during the day. Severe sleep apnoea is a potentially serious condition because it may result in hypertension, heart failure, heart attack, or stroke.

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