Medically Reviewed On: July 10, 2008

DAVID FOLK THOMAS: Welcome to our webcast. I'm David Folk Thomas.

We all know that snoring can be a big problem for the other person in the bed. But in some cases, snoring is a sign of something more serious, a condition called sleep apnea. Now what is sleep apnea and, if you snore, should you be worried?

Well, here to discuss sleep apnea and how to treat it are two experts. On my left is Dr. Daniel Wagner. He's the medical director of the Sleep-Wake Disorder Center at the New York Presbyterian Hospital in Manhattan. And also Dr. Shelley Zak. She's an attending physician at the Sleep-Wake Disorder Center at the New York Presbyterian Hospital. Dr. Wagner, Dr. Zak, thanks for joining me here today. Dr. Wagner -- well, let me start with you -- what exactly is sleep apnea?

DANIEL WAGNER, MD: "Apnea" means "without breath." And sleep apnea is a type of without breath that occurs only during sleep. The great, great majority of cases are what are obstructive sleep apnea, and in that form of the condition, the throat -- back behind your tongue -- literally get sucked closed by the chest as it's trying to pull air through it. And that's because the muscles of the throat have relaxed enough when you're asleep to allow that to happen. They would never let it happen while you're awake. You'd choke and you'd know it immediately.

That goes on for ten, twenty, thirty, sometimes sixty seconds. And the efforts of the chest finally wake the person up briefly, usually without their knowing it. And they breath a few times. Get their oxygen levels back up, and then as they fall back into light sleep, the whole business may happen again. And so that's what sleep apnea is.

DAVID FOLK THOMAS: And, Dr. Zak, this does not sound like it's a very healthy scenario.

SHELLEY ZAK, MD: Not at all. There are very good data that show an association of sleep apnea with high blood pressure, heart attacks and also, probably, stroke. It really is an important medical problem. And the person can go on for a long time not worrying about. Eh, they feel a little sleepy, they're not refreshed in the morning. The reality is this has serious public-health ramifications. And, if nothing else -- let's just forget the heart attack and stroke issue -- you're not refreshed. Because what happens, as Dr. Wagner mentioned, is that one gets into this vicious cycle. Get drowsy, you have this obstruction, and then an arousal. Drowsy, obstruct, arouse. Drowsy, obstruct, arouse. And so the sleep is extremely broken up, unrefreshing, and, if nothing else, the potential for a car accident or anyone who operates heavy machinery, is quite high. And perhaps even at that level, is our greatest sense of problem.

DAVID FOLK THOMAS: And Dr. Wagner, how do you know if you have sleep apnea? I mean, nobody ever snores, right? Because, they don't hear it themselves?

DANIEL WAGNER, MD: Right. Yeah. Many of our patients have to be convinced by either an audio or a videotape that, oh, yeah, that's them actually making all that sound.

SHELLEY ZAK, MD: Their wives.

DANIEL WAGNER, MD: Because the snorer actually never hears themselves. They're asleep and the nature of sleep is that we're cut off from sensory input, including hearing. So the snorer doesn't actually hear themselves snore, except perhaps at the end of an apnea or as they're arousing, they may [SNORTING SOUND] hear themselves snort a little bit like that. But very often, people will deny that they could possibly make that horrible noise until someone actually records it.

DAVID FOLK THOMAS: So snoring can be unrelated to sleep apnea.

DANIEL WAGNER, MD: Yes, about half of men at age 50 snore chronically or habitually. They snore at least part of every night. Probably about five to maybe eight percent of men at age 50 have sleep apnea.

DAVID FOLK THOMAS: How is sleep apnea diagnosed?

SHELLEY ZAK, MD: You go to a sleep center. The only way to diagnose it is to look at sleep and breathing. And do you breathe when you're sleeping. And so one has to go to a sleep center and have a polysomnogram or sleep study to make this diagnosis.

I actually wanted to make a point. Dr. Wagner mentioned how the incidence increases, and is quite prominent in middle age. This is very often a weight-related phenomenon. And it's very important -- if you put on some weight, and, all of a sudden, they notice you're snoring -- that's also a key. It's both weight and your anatomy and to whatever extent, that is also affected by weight.

DAVID FOLK THOMAS: And then what -- if you've been diagnosed, what can you do besides keeping slim and trim?

SHELLEY ZAK, MD: Well, that's right. I mean, there are two things. One is treatment is one is cure. And the long-term cure is usually not always, but usually, weight loss. But, you can't lose weight if you're exhausted, you're not sleeping, you have no energy.

So the short-term treatment, the most common is something called nasal CPAP. That stands for "Continuous Positive Airway Pressure," C-P-A-P. And I will bet that most of your viewers know someone who has a CPAP machine. It's a machine -- it's about the size of a loaf of bread. And it literally blows in pressurized air into the back of the throat. I mean, the problem is collapse of the back of the throat as one is breathing at night. And what this does is work as a pneumatic splint. It is pushing air into the back of the throat. It can't collapse on itself. And that sounds kind of like, "Ooh, ah, how can anyone sleep like that?" And the reality is, if someone has significant sleep apnea, they sleep wonderfully with the CPAP machine.

So the next thing is, "What about my wife? She's not going to like this," because the way to get the air in is through a mask over the nose. Wives love it. First off, their husband is breathing again. And this always, you know, reassures them, it makes them feel down. Because they see him not breathing. They go, "He stops breathing during the night." And the husbands just don't get it, because they don't see it. So, let me assure you, you're wife will be appreciative of the fact that you are breathing.

The other thing is that as long as you're wearing the CPAP, you won't snore. Most sleep centers titrate the amount of pressure, figure out how much pressure one needs and set it so that as long as the husband's wearing it, he's not snoring. And I should say -- I'm saying, "husband." I mean that's the majority. But this is also a problem in women.

DAVID FOLK THOMAS: Okay, and Dr. Wagner, just to finish us off. Briefly describe some surgical solutions to sleep apnea.

DANIEL WAGNER, MD: There are actually several. The one that's most commonly been done is to trim the soft palate and some of the side parts of that membrane. And works pretty well for snoring. Not so well for the more severe cases of sleep apnea. It fails in a lot of those cases. And, unfortunately, all too many of the surgeons tend to underemphasize the fact that this operation may fail if you have sleep apnea. So, we tend to emphasize that to patients. Since nasal CPAP will work very, very well.

There are other, more major surgeries on the throat and the jaw that can cure sleep apnea, but they're very major surgery.

And then, finally, dental appliances. They're specially-made, they need to be custom-made, so that you don't get your teeth pulled out or get temporomandibular joint syndrome, and you should go to a knowledgeable dentist. Not somebody whose just kind of doing this on the side. Who can fashion one of these devices. And what they do is pull the jaw forward, which pulls the tongue forward, makes more room in the throat, less resistance to the flow of air and less flapping of that little uvula and the soft palate. So less snoring. Those can also work for mild to moderate sleep apnea.

DAVID FOLK THOMAS: Well, a lot of different things out there. Well, Doctors, thank you for sharing your knowledge with us today. That's all the time we have. I'm David Folk Thomas and we will see you next time.