Restless zzz for sleep apnea sufferers

WALNUT CREEK, Calif. — When he fell asleep in his armchair in front of the TV, Bob Dillon, 68, would wake himself up snoring.

Worse than the snoring, though, was his constant feeling of sleepiness during the day, his short temper and less-than-clear-headed thinking.

"It was bugging me," says Dillon of Rossmoor, Calif. "So I went to my primary care physician and bugged him."

The doctor eventually sent Dillon to the California Center for Sleep Disorders in Concord, where he was hooked up to several devices that measured how he slept overnight. The doctors monitored how he slept on his back and sides, waking him only to have him turn over. When they were done, his doctor told him he had sleep apnea. The snoring, sleepiness, bad temper and muddy thinking were merely symptoms of a bigger health concern.

Snoring is not only embarrassing and annoying to bed partners, but a hassle and expensive to cure, whether it's by over-the-counter or expensive doctor-supervised treatments, which are generally not covered by insurance. But, more important, snoring is also the best indicator of sleep apnea, a potentially deadly condition in which a person's anatomy — be it the soft palates in their mouths, the size and thickness of their tongues or necks, or the condition of their nasal passages — blocks the airflow. Left untreated, doctors say sleep apnea can increase risk of high blood pressure, heart attacks, diabetes, and even car accidents due to sleepiness while driving.

"Fifty to 80 percent of snorers have sleep apnea," says Dr. Jerome Hester, an otolaryngologist (also known as an ear, nose and throat doctor or ENT) with the California Sleep Institute in Palo Alto. "Sleep apnea is an extremely serious condition. Studies have shown that untreated it can increase your chances of dying over 10 years by 15 to 20 percent."

According to the American Sleep Apnea Association, the condition literally means sleeping "without breath." There are three types — obstructive, central and mixed — and in all types, people stop breathing multiple times in their sleep, often for a minute or longer.

Most sleep apnea sufferers are male, overweight and more than 40 years old, but sleep apnea can be a condition in people regardless of age, weight or sex. Snoring in children is never normal and indicates sleep apnea, which should be addressed by a doctor, Hester says.

Doctors say the process of diagnosing sleep apnea usually starts with the complaints of the bed partners of people who snore. Often, snorers will seek out several different types of snoring treatments, from over-the-counter nasal strips, head straps and special pillows to noninvasive snoring solutions offered by plastic surgeons, dentists and specialty snoring centers like Sereno in San Francisco.

Simple snoring without apnea can be treated with some effectiveness by the Pillar Procedure, an FDA-approved, minimally invasive outpatient operation where three to five tiny polyester implants are placed into the soft palate of the mouth, stiffening it so it doesn't vibrate as much while sleeping. A vibrating palate is one of the causes of snoring but also indicative of sleep apnea.

"Patients don't know these solutions (like the Pillar Procedure) exist for snoring," says Dr. Matthew Mingrone of Sereno, also an otolaryngologist. Sereno, like many sleep centers in the Bay Area, also offers procedures like nasal turbinate reduction, where radio-frequency reduces the size of the turbinates (soft tissue) in the nose. Uvulectomies (which reduce the size of the flesh that hangs between your tonsils) and lifestyle programs that challenge snorers to lose weight are also offered. An excess of body fat is often associated with both snoring and sleep apnea.

Yet snoring treatments are controversial, to say the least, in the ENT and sleep medicine fields.

Dr. Hester of the California Sleep Institute says he worries that people who address snoring only with anti-snoring surgeries will mask the real problem. Curing snoring does not cure apnea, though some apnea treatments can reduce snoring.

Sereno and some plastic surgeons do not require sleep studies before performing surgery, though Dr. Mingrone says he welcomes the results of sleep studies for treatment of prospective patients. Sleep studies are usually covered by medical insurance.

Dr. Chad Ruoff, a fellow at Stanford Sleep Medicine Center, says the gold standard for snoring and sleep apnea are not nasal turbinate or Pillar procedures but the continuous positive airway pressure machine, known as the CPAP. Though not sexy and sometimes uncomfortable to snorers and loud for their bed partners, proper and consistent use of a CPAP machine will reduce the chances of apnea-related health problems. A CPAP user wears a mask, a nasal pillow or a nose mask device over their face while sleeping. The machine then pumps a continuous stream of air into the user's mouth or nose, keeping breathing passages open with the constant flow of air. This prevents the person's anatomy from shutting off airways typical in sleep apnea.

A CPAP machine is not the only way to treat the condition, and doctors say only about 40 percent of patients can tolerate the CPAP device. Sometimes more intense procedures are performed. These include breaking the nose and jaw, or removing tissue in the uvula, soft palate, tonsils, adenoids and the pharynx.

And Dr. Jennifer Bock Hughes, a otolaryngologist with Ear, Nose & Throat Associates in San Mateo who specializes in sleep medicine, says though many different snoring treatments can calm the ruckus for the nonapnea snorer, no procedure is safe without a determination of whether or not the snorer has sleep apnea.

"If it was my family member, if there was any question of them having sleep apnea," she says, "I'd want a sleep study."

Since being taught by the clinic how to use his CPAP machine seven years ago, Dillon says his life has changed dramatically. He now gets plenty of rest, and his mood is better, his thinking is more clear.

"It was almost immediate," he says. "I was transformed."