Snoring vs. Sleep Apnea

Snoring and sleep apnea are not the same thing. While many people think that sleep apnea is the same thing as snoring, it’s not. It is important to understand the difference between the two because while some people suffering from sleep apnea might snore, not all snorers have sleep apnea. To help you better understand sleep apnea, let’s look at how it is different from snoring.

An interesting fact about sleep apnea versus snoring is that while both may involve disruptions in breathing during sleep, they differ significantly in severity and potential health implications.

Snoring is often a common and harmless occurrence caused by the vibration of relaxed throat tissues. On the other hand, sleep apnea is a more serious condition characterized by repeated pauses in breathing, leading to oxygen deprivation and potential health risks.

What is snoring?

About 45% of adults snore at least occasionally, while about 25% are habitual snorers. But the real question is, what causes snoring? The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing.

Additionally, snoring can be both socially and medically disabling for various reasons. Socially, it can make the snorer an object of ridicule, receiver of the middle of the night elbow jabs, and can cause the bed partner to experience sleepless nights and fatigue. Medically, it disturbs sleeping patterns and deprives the snorer of adequate rest, but it can also be a sign of sleep apnea.

What’s the difference between snoring and sleep apnea?

It's true that snoring is a common symptom of sleep apnea--however, just because you snore does not mean you have sleep apnea, and just because you have sleep apnea it does not necessarily mean you will snore.

Either way, it is important to seek medical attention for proper diagnosis and treatment options. If you snore and might be concerned that you have sleep apnea, talk to your dentist or doctor.

If you have any questions about snoring and sleep apnea, please contact Seattle Sleep & Smile. We can work with you to determine if your snoring is sleep apnea.

Causes of Sleep Apnea

The most common form of sleep apnea is obstructive sleep apnea, which is caused by a blockage of the breathing passage or a collapsed airway. With a blocked airway, it is difficult to breathe—keeping air from traveling freely.

When you’re awake, throat muscles help keep your airway activated and open so air can flow into your lungs. When you sleep, these muscles relax, which narrows your throat. Normally, this narrowing of your throat doesn’t prevent air from flowing into and out of your lungs.

However, if you have sleep apnea, your airway can become partially or fully blocked because of the following reasons:

• Excess weight
• Neck circumference
• A narrowed airway
• Being male
• Being older
• Family history
• Use of alcohol, sedatives or tranquilizers
• Smoking
• Nasal congestion
• Medical conditions

As a result, not enough air flows into your lungs if your airway is partially or fully blocked during sleep. In the end, you or your loved one will experience loud snoring and a drop in your blood oxygen level.

Obstructive Sleep Apnea

This type of sleep apnea happens when the muscles in the back of the throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate called the uvula, the tonsils, the side walls of the throat and the tongue.

When the muscles relax, your airway narrows or closes as you breathe in. You can't get enough air, which can lower the oxygen level in your blood. Your brain senses that you can't breathe, and briefly wakes you so that you can reopen your airway. This awakening is usually so brief that you don't remember it.

You might snort, choke or gasp. This pattern can repeat itself 5 to 30 times or more each hour, all night. This makes it hard to reach the deep, restful phases of sleep.

Risk factors for Obstructive Sleep Apnea

Sleep apnea can affect anyone, even children. But certain factors increase your risk.

Factors that increase the risk of this form of sleep apnea include:

• Excess weight - obesity greatly increases the risk of OSA. Fat deposits around your upper airway can obstruct your breathing.
• Neck circumference - people with thicker necks might have narrower airways.
• A narrowed airway - you might have inherited a narrow throat. Tonsils or adenoids also can enlarge and block the airway, particularly in children.
• Being male - men are 2 to 3 times more likely to have sleep apnea than are women. However, women increase their risk if they're overweight, or if they've gone through menopause.
• Being older - sleep apnea occurs significantly more often in older adults.
• Family history - having family members with sleep apnea might increase your risk.
• Use of alcohol, sedatives or tranquilizers - these substances relax the muscles in your throat, which can worsen obstructive sleep apnea.
• Smoking - smokers are three times more likely to have obstructive sleep apnea than are people who've never smoked. Smoking can increase the amount of inflammation and fluid retention in the upper airway.
• Nasal congestion - if you have trouble breathing through your nose — whether from an anatomical problem or allergies — you're more likely to develop obstructive sleep apnea.
• Medical conditions - congestive heart failure, high blood pressure and type 2 diabetes are some of the conditions that may increase the risk of obstructive sleep apnea. Polycystic ovary syndrome, hormonal disorders, prior stroke and chronic lung diseases such as asthma also can increase risk.

How can I reduce my risk or prevent sleep apnea?

Sleep apnea is sometimes preventable, especially in cases where it happens because a person has excess weight or obesity. Still, some people maintain a healthy body weight or are underweight and still develop sleep apnea. For those individuals, a structural issue is usually the cause of their apnea, so they can’t prevent it.

The best things you can do to reduce your risk of sleep apnea include:

• Reach and maintain a healthy weight
• Practice good sleep hygiene
• Manage any existing health conditions, such as high cholesterol, high blood pressure and Type 2 diabetes.
• See your healthcare provider at least once a year for a checkup.

Complications of sleep apnea

Sleep apnea is a serious medical condition. Complications of OSA can include:

• Daytime fatigue - the repeated awakenings associated with sleep apnea make typical, restorative sleep impossible, in turn making severe daytime drowsiness, fatigue and irritability likely. You might have trouble concentrating and find yourself falling asleep at work, while watching TV or even when driving. People with sleep apnea have an increased risk of motor vehicle and workplace accidents. You might also feel quick-tempered, moody or depressed. Children and adolescents with sleep apnea might perform poorly in school or have behavior problems.
• High blood pressure or heart problems - sudden drops in blood oxygen levels that occur during OSA increase blood pressure and strain the cardiovascular system. Having OSA increases your risk of high blood pressure, also known as hypertension.
  OSA might also increase your risk of recurrent heart attack, stroke and irregular heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.

• Type 2 diabetes - having sleep apnea increases your risk of developing insulin resistance and type 2 diabetes.
• Metabolic syndrome - this disorder, which includes high blood pressure, abnormal cholesterol levels, high blood sugar and an increased waist circumference, is linked to a higher risk of heart disease.
• Complications with medicines and surgery - obstructive sleep apnea is also a concern with certain medicines and general anesthesia. People with sleep apnea might be more likely to have complications after major surgery because they're prone to breathing problems, especially when sedated and lying on their backs. Before you have surgery, tell your doctor about your sleep apnea and how it's being treated.
• Liver problems - people with sleep apnea are more likely to have irregular results on liver function tests, and their livers are more likely to show signs of scarring, known as nonalcoholic fatty liver disease.
• Sleep-deprived partners - loud snoring can keep anyone who sleeps nearby from getting good rest. It's common for a partner to have to go to another room, or even to another floor of the house, to be able to sleep.

How sleep apnea disrupts your sleep cycle

Your brain constantly monitors your body’s status and adjusts your heart rate, blood pressure, breathing, etc. Your blood oxygen levels can drop when you stop breathing because of either apnea or hypopnea.

• Apnea - this is when you stop breathing while asleep or have almost no airflow.
• Hypopnea - this means you aren’t breathing enough to maintain oxygen levels in your blood.

Your brain reacts to blood oxygen drops — from either apnea or hypopnea — by triggering a failsafe-like reflex, waking you up enough for you to breathe again. Once you resume breathing, your brain automatically tries to resume your sleep cycle.

The more severe your sleep apnea is, the more often you’ll these interruptions happen. The apnea/hypopnea index (AHI) is the average hourly number of apnea or hypopnea events — times when a person stops breathing. The AHI is the main factor determining the severity of sleep apnea. The severity is as follows:

• Mild sleep apnea - This level means a person has an AHI between 5 and 15. That means they have between 5 and 15 apnea or hypopnea events per hour. However, healthcare providers also consider symptoms at this level. If you don’t have other symptoms, they may not consider it severe enough to treat.
• Moderate sleep apnea - people with moderate sleep apnea have between 15 and 29 events per hour. That means a person who sleeps eight hours stops breathing and/or wakes up between 120 and 239 times.
• Severe sleep apnea - people with severe sleep apnea wake up 30 or more times in an hour. That means they stop breathing and/or wake up 240 times or more during a full eight hours of sleep.

Obstructive events, which are very short-lived, can affect any stage of sleep. They’re most common in Stage 1, Stage 2 and REM sleep. That’s why it’s common for people to not remember apnea events, which means they may not know they have a problem until the symptoms are noticeable.

Diagnosis and Tests

How is sleep apnea diagnosed? Diagnosing sleep apnea usually involves a healthcare provider asking questions about your symptoms and history. If they suspect sleep apnea based on your symptoms and answers, they’ll likely want you to undergo testing for sleep apnea.

Click to download the Epworth Sleepiness Scale questionnare (.pdf)

What tests will be done to diagnose sleep apnea? The most common tests for sleep apnea include:

• Overnight sleep study (polysomnogram) - this is an overnight test where you sleep in a medical facility (often known as a “sleep lab”) that’s specially equipped to be as comfortable as possible while still monitoring your sleep. This test involves sensors that monitor your heart rate, breathing, blood oxygen levels, brain waves and more.
• Home sleep apnea testing - this form of testing allows a person to complete a sleep study from home. It’s similar to an overnight sleep study, but doesn't involve brain wave monitoring. This test can’t diagnose central sleep apnea.